Clinicopathologic variables affecting survival of distal colorectal cancer patients with macroscopic invasion into the adjacent organs

A total of 506 distal colorectal cancer patients were classified into two groups, to clarify the variables affecting survival of the patients with macroscopic invasion into the adjacent organs: 47 cases showed invasion (invasive group) while the other did not show invasion (noninvasive group). Differences between the invasive and noninvasive groups were found in eight variables; female, large tumor size, gross types 3 and 4, moderately or poorly differentiated adenocarcinomas and signet-ring cell or mucinous carcinomas, deep cancer invasion, lymphatic invasion, peritoneal and liver metastases, and curability B-C were found significantly more frequently in the invasive group. The survival curve of the former was significantly (P < 0.05) lower than that of the latter. However, no significant difference was found between the survival curves of the patients with curability A (no residual tumors) in both groups. A multivariate analysis in the invasive groups revealed six variables to be significantly related to a good prognosis including a young age, females, a location above the peritoneal reflection, well differentiated adenocarcinoma, negative lymphatic invasion, and curability A. Surgery with curability A should be performed to improve the survival in distal colorectal cancer patients with macroscopic invasion into the adjacent organs.

Cucumber cotyledon lipoxygenase during postgerminative growth. Its expression and action on lipid bodies

In cucumber (Cucumis sativus), high lipoxygenase-1 (LOX-1) activity has been detected in the soluble fraction prepared from cotyledons of germinating seeds, and the involvement of this enzyme in lipid turnover has been suggested (K. Matsui, M. Irie, T. Kajiwara, A. Hatanaka [1992] Plant Sci 85: 23-32; I. Fuessner, C. Wasternack, H. Kindl, H. Kühn [1995] Proc Natl Acad Sci USA 92: 11849-11853). In this study we have investigated the expression of the gene lox-1, corresponding to the LOX-1 enzyme. LOX-1 expression is highly coordinated with that of a typical glyoxysomal enzyme, isocitrate lyase, during the postgerminative stage of cotyledon development. In contrast, although icl transcripts accumulated in tissue during in vitro senescence, no accumulation of lox-1 mRNA could be observed, suggesting that lox-1 plays a specialized role in fat mobilization. LOX-1 is also known to be a major lipid body protein. The partial peptide sequences of purified LOX-1 and lipid body LOX-1 entirely coincided with that deduced from the lox-1 cDNA sequence. The data strongly suggest that LOX-1 and lipid body LOX-1 are derived from a single gene and that LOX-1 can exist both in the cytosol and on the lipid bodies. We constructed an in vitro oxygenation system to address the mechanism of this dual localization and to investigate the action of LOX-1 on lipids in the lipid bodies. LOX-1 cannot act on the lipids in intact lipid bodies, although degradation of lipid body proteins, either during seedling growth or by treatment with trypsin, allows lipid bodies to become susceptible to LOX-1. We discuss the role of LOX-1 in fat mobilization and its mechanism of action.

Expression of nm23-H1 in colorectal cancer: no association with metastases, histological stage, or survival

The correlations of nm23-H1 expression in primary cancer lesions with the already confirmed 14 prognostic variables and survival were examined in 52 advanced colorectal cancer patients, because the clinical roles of nm23-H1 expression in the cancer lesions remain controversial. An immunohistochemical expression of nm23-H1 was found in 23 lesions (positive group) but not found in 29 lesions (negative group). No significant difference between the positive and negative groups was found according to 12 clinicopathological variables including vascular invasion, lymph node and liver metastases, and histological stage. The carcinoembryonic antigen levels (21.5+/-33.4 ng/ml) of the draining venous blood and argyrophilic nucleolar organizer regions score (3.35+/-1.36 per nucleus) of the cancer cells in the positive group were not significantly diffeent from those (34.1+/-102.9 ng/ml and 3.32+/-1.00 per nucleus, respectively) in the negative group. In addition, no significant difference was found in the survival curves or the 5-year survival rates of the positive and negative groups. From these results, it may be concluded that the nm23-H1 expression was not associated with the aforementioned prognostic variables and the prognosis of advanced colorectal cancer patients.

Immunohistochemical evaluation of thymidylate synthase in gastric carcinoma using a new polyclonal antibody: the clinical role of thymidylate synthase as a prognostic indicator and its therapeutic usefulness

BACKGROUND

Before this study was conducted, the clinical and therapeutic significance of immunohistochemical evaluation of thymidylate synthase (TS) in patients with gastric carcinoma had not yet been clarified.

METHODS

TS was immunohistochemically evaluated in 134 gastric carcinomas using anti-TS antibody. TS expression, 11 clinicopathologic variables, and survival were studied, and the correlations among them were investigated.

RESULTS

The groups with high and low TS levels consisted of 56 and 78 patients, respectively. Granular cytoplasmic staining patterns of tumor cells were produced by immunohistochemical staining of the gastric carcinoma tissues. The grade of TS staining was significantly correlated with three clinicopathologic variables: depth of invasion, peritoneal metastasis, and stage of the carcinoma (P < 0.05). A univariate analysis revealed that the 5-year survival was significantly better for the low TS group than for the high TS group (P < 0.05): 65.2% for the low TS group and 43.2% for the high TS group. The group with high grade TS staining who received chemotherapy because of the advanced stage of their disease had worse prognoses even if they received adjuvant chemotherapy. A multivariate analysis revealed that four variables (peritoneal metastasis, lymphatic invasion, liver metastasis, and TS staining grade) independently contributed to survival (P < 0.05). The hazard ratio for the group with low grade TS staining was 0.464 compared with the group with high grade staining.

CONCLUSIONS

The immunohistochemical evaluation of TS using this anti-TS antibody may be clinically and therapeutically useful in determining the prognosis of gastric carcinoma patients.

Evaluation of argyrophilic nucleolar organizer region and proliferating cell nuclear antigen in colorectal cancer

BACKGROUND AND OBJECTIVES

Information on cellular proliferation is gaining importance for predicting prognosis in several cancers. To clarify the clinicopathological significance of argyrophilic nucleolar organizer region (AgNOR), proliferating cell nuclear antigen (PCNA), and DNA ploidy pattern, we studied their correlations with clinicopathological factors in colorectal cancer.

METHODS

Fifty-two patients with colorectal cancer were examined by AgNOR staining, immunohistochemical study of PCNA expression, and DNA flow cytometry.

RESULTS

The AgNOR score and the PCNA labeling rate (PCNA LR) were significantly higher in patients with deep invasion (P = 0.0072, P = 0.0355), liver metastasis (P = 0.0022, P = 0.0001), and Dukes D classification (P = 0.0002, P = 0.0001) than in patients without these factors. In patients with high AgNOR score (>3.83) or with high PCNA LR (>48.8), prognosis was significantly worse (P = 0.0002, P = 0.0123) than in those with low AgNOR score (<3.83) or in those with low PCNA LR (<48.8), respectively. No significant association was observed between AgNOR score and PCNA LR. Combined analysis revealed that the survival curve for patients with high AgNOR score and high PCNA LR was significantly lower (P = 0.0156) than that for patients with high AgNOR score and low PCNA LR. There was no significant correlation between DNA ploidy pattern and clinicopathological findings.

CONCLUSIONS

PCNA LR and AgNOR score were correlated not only with local progression but also with metastasis. Their determination provided useful prognostic information, and these parameters are probably independent. Their simultaneous determination was useful for accurate evaluation of prognosis. The value of DNA ploidy pattern was uncertain.

Immunohistochemical evaluation of thymidylate synthase in gastric carcinoma using a new polyclonal antibody: the clinical role of thymidylate synthase as a prognostic indicator and its therapeutic usefulness

BACKGROUND

Before this study was conducted, the clinical and therapeutic significance of immunohistochemical evaluation of thymidylate synthase (TS) in patients with gastric carcinoma had not yet been clarified.

METHODS

TS was immunohistochemically evaluated in 134 gastric carcinomas using anti-TS antibody. TS expression, 11 clinicopathologic variables, and survival were studied, and the correlations among them were investigated.

RESULTS

The groups with high and low TS levels consisted of 56 and 78 patients, respectively. Granular cytoplasmic staining patterns of tumor cells were produced by immunohistochemical staining of the gastric carcinoma tissues. The grade of TS staining was significantly correlated with three clinicopathologic variables: depth of invasion, peritoneal metastasis, and stage of the carcinoma (P < 0.05). A univariate analysis revealed that the 5-year survival was significantly better for the low TS group than for the high TS group (P < 0.05): 65.2% for the low TS group and 43.2% for the high TS group. The group with high grade TS staining who received chemotherapy because of the advanced stage of their disease had worse prognoses even if they received adjuvant chemotherapy. A multivariate analysis revealed that four variables (peritoneal metastasis, lymphatic invasion, liver metastasis, and TS staining grade) independently contributed to survival (P < 0.05). The hazard ratio for the group with low grade TS staining was 0.464 compared with the group with high grade staining.

CONCLUSIONS

The immunohistochemical evaluation of TS using this anti-TS antibody may be clinically and therapeutically useful in determining the prognosis of gastric carcinoma patients.

Evaluation of argyrophilic nucleolar organizer region and proliferating cell nuclear antigen in colorectal cancer

BACKGROUND AND OBJECTIVES

Information on cellular proliferation is gaining importance for predicting prognosis in several cancers. To clarify the clinicopathological significance of argyrophilic nucleolar organizer region (AgNOR), proliferating cell nuclear antigen (PCNA), and DNA ploidy pattern, we studied their correlations with clinicopathological factors in colorectal cancer.

METHODS

Fifty-two patients with colorectal cancer were examined by AgNOR staining, immunohistochemical study of PCNA expression, and DNA flow cytometry.

RESULTS

The AgNOR score and the PCNA labeling rate (PCNA LR) were significantly higher in patients with deep invasion (P = 0.0072, P = 0.0355), liver metastasis (P = 0.0022, P = 0.0001), and Dukes D classification (P = 0.0002, P = 0.0001) than in patients without these factors. In patients with high AgNOR score (>3.83) or with high PCNA LR (>48.8), prognosis was significantly worse (P = 0.0002, P = 0.0123) than in those with low AgNOR score (<3.83) or in those with low PCNA LR (<48.8), respectively. No significant association was observed between AgNOR score and PCNA LR. Combined analysis revealed that the survival curve for patients with high AgNOR score and high PCNA LR was significantly lower (P = 0.0156) than that for patients with high AgNOR score and low PCNA LR. There was no significant correlation between DNA ploidy pattern and clinicopathological findings.

CONCLUSIONS

PCNA LR and AgNOR score were correlated not only with local progression but also with metastasis. Their determination provided useful prognostic information, and these parameters are probably independent. Their simultaneous determination was useful for accurate evaluation of prognosis. The value of DNA ploidy pattern was uncertain.

Relations of nm23 expression to clinicopathologic variables and proliferative activity of gastric cancer lesions

Relationships of nm23 expression and 12 clinicopathologic variables and proliferative activity of cancer cells were examined in 55 gastric cancer patients to clarify the effects of nm23 expression on the factors and activity in gastric cancer. Expression of nm23 was determined by immunohistochemically stained sections using a monoclonal antibody, nm23H-1. Proliferative activity was immunohistochemically evaluated by proliferating cell nuclear antigen (PCNA) labeling index (LI) using a monoclonal antibody PC10. Expression of nm23 was found in 24 lesions (positive group) but not in 31 lesions (negative group). With regard to clinicopathologic variables, a significant (p < 0.05) difference between the positive and negative groups was found in 1 of the 12 factors, depth of cancer invasion. PCNA LI (48.9 +/- 11.6%) of the former group was significantly (p < 0.05) higher than that (40.3 +/- 12.6%) ot the latter, although multiple regression analysis showed that nm23 expression was not one of the most influencing variables for PCNA LI. The results may suggest that expression of nm23 in gastric cancer lesions is correlated to tumor progression and/or proliferation rather than suppression of metastasis.

[Perioperative management for nephrectomy in a long-term hemodialysis patient with anticoagulants for coronary stent]

A 53-year old man on long-term hemodialysis (HD) with anticoagulant therapy was scheduled for nephrectomy due to renal cell carcinoma. Two months before surgery, a coronary stent had been placed due to right coronary artery disease. One week before surgery, percutaneous transmural coronary angioplasty (PTCA) was performed for unstable angina. Aggressive oral antiplatelet therapy (aspirin and ticlopidine) was absolutely required to maintain patency. Following withdrawal of the antiplatelets, unfractionated heparin (UFH) was titrated to an activated partial thromboplastin time (APTT) of 1.5 times greater than the control value. Maintenance UFH (800 U.h-1) was continued until the time of arrival in the operation room (activated clotting time (ACT) was 166 seconds). One hour after arrival, reduced dose of UFH (200 U.h-1) was reinfused, and ACT was 121 140 seconds. Hemodynamic change was minimized using balanced general anesthesia (nitrous oxide-isoflurane, fentanyl, midazolam and vecuronium) accompanied by nitroglycerin and diltiazem. There was no ischemic change on ECG or transesophageal echocardiography. Following surgery, the UFH dose was augmented (400 U.h-1), and the maintenance dose was attained 11 hours after surgery. HD on the second postoperative day was performed uneventfully. This hemodynamic stability might be come from the no water removal. Fourteen days after surgery, the patient was discharged without hemorrhagic complications or clinical ischemic events. We conclude that perioperative UFH infusion is not contraindicated for dialysis patient if strict ACT control is maintained.

Establishment and characterization of tracheal epithelial cell lines, TM01 and TM02-3, from transgenic mice bearing temperature-sensitive simian virus 40 large T-antigen gene

Murine tracheal epithelial cell lines, TM01 and TM02-3, were established from a primary culture of tracheal cells of adult transgenic mice bearing a temperature-sensitive simian virus (SV40) large T-antigen gene. Both TM01 and TM02-3 cells, which grew until confluent monolayers were formed, maintained tight contact with neighboring cells, and retained the characteristics of epithelial cells with microvilli on the surface. These cells grew at a permissive temperature (33 degrees C), but did not at a nonpermissive temperature (39 degrees C), indicating that TM01 and TM02-3 cells undergo temperature-sensitive growth. Large T-antigen was expressed only in the nuclei at 33 degrees C. Sepharose CL-4B column chromatography using a 14C-glucosamine hydrochloride, indicating that both cells produced high molecular weight glycoconjugates, and suggesting that these cells may originate from mucus-producing cells. TM01 cells expressed intercellular adhesion molecular-1 (ICAM-1) in both unstimulated and stimulated (1,000 U/ml tumor necrosis factor-alpha and 500 U/ml interferon-gamma) conditions, whereas TM02-3 cells expressed ICAM-1 only under stimulated conditions. We conclude that these cell lines may serve as a useful model to study the tracheal cell functions under defined in vitro conditions.

Synthesis of phenoxyacetic acid derivatives as highly potent antagonists of gastrin/cholecystokinin-B receptors. II

A series of phenoxyacetanilide derivatives was synthesized and their antagonist activities for human gastrin/cholecystokinin (CCK)-B and CCK-A receptors were evaluated. Among the compounds synthesized, 2-[3-[3-[N-[2-(N-methyl-N-phenylcarbamoylmethoxy)phenyl]-N-(N-meth yl-N- phenylcarbamoylmethyl)carbamoylmethyl]-ureido]phenyl]acetic acid (20i, DA-3934) exhibited high affinity for gastrin/CCK-B receptors and high selectivity over CCK-A receptors. DA-3934 and its methyl ester derivative inhibited pentagastrin-induced gastric acid secretion in rats in a dose-dependent manner.

Colonic obstruction induced by plasma cell granuloma of the transverse colon: report of a case

Plasma cell granuloma is mainly composed of reactive plasma cell proliferation, the origin of which is uncertain. Immunohistochemically, the plasma cells are characterized by a polyclonal nature, and must be distinguished from plasmacytoma which displays a monoclonal nature. This tumor is most commonly found in the lung and bronchus, but has rarely been described in the alimentary tract. We report herein a case of plasma cell granuloma of the transverse colon. A 71-year-old woman was admitted for lower abdominal pain with severe inflammation and anemia. Ultrasound examination and computed tomography showed an abdominal tumor. Barium enema revealed the tumor to be located in the transverse colon causing colonic obstruction. The resected tumor was spherical and mainly spread in the submucosal layer. Microscopically, the tumor consisted of severe infiltration of mature plasma cells within the spindle-shaped myofibroblasts. Immunohistochemical studies showed IgA, IgG, IgM, and kappa and lambda chains, and revealed a polyclonal nature of the plasma cells. Thus, a pathological diagnosis of plasma cell granuloma affecting the transverse colon was made. To the best of our knowledge, this is the first report of successful surgical resection of plasma cell granuloma of the colon.

A predictive value of carcinoembryonic antigen in draining venous blood for colorectal cancer patients with postoperative hematogenous metastases

Correlations between carcinoembryonic antigen (CEA) levels of peripheral (p) and draining (d) venous blood and postoperative hematogenous metastases (HM) were examined in 76 advanced (T2-4) colorectal adenocarcinoma patients, to clarify a predictive value of dCEA and the gradient (d-pCEA) between d- and pCEA levels in patients with HM. HM were found in 19 patients (HM group), but not found in 57 patients (non-HM group). The mean value (27.4 ng/ml) of dCEA and positive rates (100 and 89.5%) of d- and d-pCEA levels were significantly higher than those (9.8 ng/ml and 57.9%) of pCEA in the HM group, though no significant difference was found among p-, d-, and d-pCEA values and positive rates in the non-HM group. Significant linear correlations, Y (log dCEA, ng/ml) = -0.039X (month) + 2.016 and Y (log d-pCEA, ng/ml) = -0.039X (month) + 1.823, were found between d- and d-pCEA levels and HM-diagnostic period. These results suggest that colorectal cancer patients with HM are more effectively predicted by the determination of d- and d-pCEA levels than of pCEA levels and that they are patients with positive d- and d-pCEA levels. These patients seem to have a high possibility of early HM.

Relationship among risk factors of atherosclerosis, leukocyte count, and soluble intercellular adhesion molecule-1

We investigated the effects of risk factors of atherosclerosis on soluble intercellular adhesion molecule-1 (sICAM-1) concentration and leukocyte count by using multivariate statistical analysis. The subjects were 90 people who were hospitalized for a complete check-up examination. Eight risk factors were selected as candidates for predictor variables: age, body mass index (BMI), uric acid, glycohemoglobin A1c, number of cigarettes smoked daily, total cholesterol, triglyceride, and high density lipoprotein (HDL)-cholesterol. The predictor variables were selected using a stepwise method, [criterion variable - predictor variable (standardized regression coefficient)]; sICAM1 - age (0.1859), number of cigarettes (0.2558), triglyceride (0.2447); leukocytes - number of cigarettes (0.2827), triglyceride (0.2526), HDL-cholesterol (-0.2800); stab leukocytes - number of cigarettes (0.2460); segmented leukocytes - glycohemoglobin A1c (0.1495), number of cigarettes (0.2716), HDL-cholesterol (-0.3254); lymphocytes - BMI (0.2639), number of cigarettes (0.1495), triglyceride (0.3520); monocytes - glycohemoglobin A1c (0.2617). These findings indicated that the risk factors of atherosclerosis may influence sICAM1 concentration and leukocyte count.

Immortalized gastric epithelial cell line GSM06 synthesizes hyaluronan under the influence of simian virus 40 large T-antigen expression

GSM06 is a cell line established from the stomach of transgenic mouse harboring a temperature-sensitive simian virus 40 (SV40) large T-antigen gene. 3H-labeled macromolecules produced by the cells incubated with [3H] glucosamine were characterized to examine whether or not GSM06 cells synthesize mucin (mucus glycoprotein). The GSM06 cells grew until a confluent monolayer formed at 33 degrees C (the permissive temperature for SV40 large T-antigen expression), and the 3H-labeled macromolecules appeared in both cell extract and medium during culture for at least 1 week. Unexpectedly, almost all 3H-labeled macromolecules, which were excluded from a column of Sepharose CL-4B, were identified as hyaluronan by analyses using Sepharose CL-2B chromatography, cesium trifluoroacetate equilibrium centrifugation, treatment with dithiothreitol, and trypsin, hyaluronidase, and chondroitinase ABC digestion. At a nonpermissive temperature (39 degrees C), GSM06 cells grew only slightly, but produced much more hyaluronan than at 33 degrees C. The results indicate that GSM06 cells produce not mucin, but hyaluronan, and that the expression of large T-antigen may influence hyaluronan synthesis in GSM06 cells.

Insulin stimulates production of glycoconjugate layers on the cell surface of gastric surface mucous cell line GSM06

The mechanism of regulation of mucus production in the gastric mucosa remains unclear. Recently, we established a gastric surface mucous cell line GSM06, which produces periodic acid-Shiff (PAS)-positive glycoconjugate (mucus) layers on the cell surface, from transgenic mice harboring a temperature-sensitive simian virus 40 large T-antigen gene. In this study, GSM06 cells were examined for its production of PAS-positive glycoconjugate layers to acid secretagogues and growth factors. The cells were cultured at nonpermissive temperature (39 degrees C) for 3-18 days and stained with PAS. Insulin (1-30 microg/ml; 0.29-8.6 microM) time- and dose-dependently increased production of glycoconjugates on the cell surface. When glycoconjugate layers produced by stimulation of insulin (3-30 microg/ml; 0.86-8.6 microM) were removed from the cell surface of GSM06 cells by a mild trypsin treatment, PAS-positive materials were remarkably decreased (day 18). In addition, morphological findings indicate that a high concentration of insulin (30 microg/ml; 8.6 microM) produced thick PAS-positive glycoconjugate layers just like normal gastric surface mucosa on the cell surface on day 18. In contrast, histamine (0.1-100 microM), carbachol (0.1-100 microM), gastrin-17 (0.1-100 nM), epidermal growth factor (0.01-10 ng/ ml; 1.7-1,700 pM), transforming growth factor-alpha (0.01-10 ng/ml; 1.8-1,800 pM), and fetal bovine serum (1-10%) did not increase glycoconjugate production. These findings suggest that insulin is a stimulator of glycoconjugate production, and stimulates production of glycoconjugate layers on the cell surface in the gastric surface mucous cell line GSM06.

Measurement of portal venous flow velocity with an implantable miniature Doppler probe in pig liver transplantation

Portal venous flow (PVF) was serially monitored after pig liver transplantation (LTX) with the use of an implantable, miniature Doppler probe developed in our laboratory. Throughout the study period, the mean PVF in pigs that underwent LTX was significantly greater than that in pigs that were sham operated. For three animals with early graft failure secondary to primary nonfunction and for six that survived longer than 7 days, the mean PVF on postoperative day (POD) 1 was 18.7 +/- 3.8 cm/s and 41.7 +/- 11.2 cm/s, respectively (P < 0.05). For animals with acute cellular rejection (ACR), the mean PVF was 61.3 +/- 9.9 cm/s on POD 7 and 54.3 +/- 6.38 cm/s on POD 14. These values were significantly higher than those for animals without ACR (P < 0.05). Moreover, the increase in PVF correlated well with the degree of ACR. The actual PVF volume was measured by ex vivo perfusion, which showed a clear correlation with the PVF velocity obtained with the implanted, miniature Doppler probe. We feel that the liver graft requires increased PVF volume after transplantation to facilitate functional recovery from damage to hepatocytes due to preservation-reperfusion injury, and that ACR is also associated with an increased PVF. We conclude that monitoring the PVF in the early postoperative period after LTX is useful in the evaluation of graft function, particularly for predicting primary nonfunction and severity of ACR.

Polymorphism of the apolipoprotein E and angiotensin-converting enzyme genes in Japanese subjects with silent myocardial ischemia

The apolipoprotein epsilon4 allele and homozygous deletion allele (DD) of the angiotensin-converting enzyme gene are reported to be associated with an increase in the incidence of ischemic heart disease. In this study, we examined whether the apolipoprotein epsilon4 genotype and angiotensin-converting enzyme/DD allele are associated with silent myocardial ischemia. We screened 3920 subjects undergoing general checkups who no symptoms of ischemic heart disease. Seventy subjects (2 percent) showed ischemic ST-segment depression during the double two-step exercise test. One hundred and twenty control subjects without ischemic ST-segment depression were recruited from the same population and matched for sex, age, and blood pressure. We performed genotyping of the apolipoprotein E gene (epsilon2, epsilon3, and epsilon4) and angiotensin-converting enzyme gene (I and D) using polymerase chain reaction-restriction fragment length polymorphism and polymerase chain reaction, respectively. Allele frequently of epsilon4 of the apolipoprotein E gene was higher in the ischemic group (11 percent) than the nonischemic group (5 percent) (chi2 = 5.35, P < .05), but there was no significant association between the allele or the genotype frequency of the angiotensin-converting enzyme gene and the incidence of ischemic ST-segment depression. Furthermore, stepwise multiple regression analysis also revealed that total cholesterol level and epsilon4 genotype were predictors of ischemic change in the exercise tolerance test (chi2 = 12.8, P < .005, R(2) = .051). These results suggest that the apolipoprotein epsilon4 allele is an independent genetic risk factor for silent myocardial ischemia in Japanese subjects.

[A reused suction catheter was broken and produced a tracheobronchial foreign body]

We present a rare case involving a broken suction catheter that became lodged in the tracheobronchial tree. An eight-month-old infant was scheduled for hernioplasty. Following intubation with a 4 French (Fr.) endotracheal tube, a 5 Fr. reused suction catheter was applied for suctioning a moderate amount of secretion. This catheter had been resterilized by ethylene oxide gas (EOG). Insertion of the catheter into the tube was not done smoothly, and we could not obtain any secretion. During the extraction of the suction catheter by force, the catheter broke. The distal fragment (20 cm length) seemed to have been lodged in the tracheobronchial tree. Prior to its removal by bronchoscopy, the endotracheal tube was extubated. Fortunately the remaining part of the catheter come out with the tube. Ten cm of the fractured catheter was included in the tube and 5 cm protruded from the tube. The catheter of smaller diameter is easy to be broken even by weaker force. After resterilization by EOG for once, there was no change in length and force at breaking point. Elongation of the broken catheter (85.5%) was less compared with the new sample (155%). At the breaking point, half of the cross section was very smooth and looked as if it had been cut by a razor, while the other half appeared to have been broken by pulling. The break may have started from the crack which had occurred at the insertion or resterilization. Therefore, we should restrict the reuse of small suction catheters, and should always utilize the catheter of the largest size possible.

Serum carcinoembryonic antigen levels and proliferating cell nuclear antigen labeling index for patients with colorectal carcinoma. Correlation with tumor progression and survival

BACKGROUND

Clinicopathologic variables, carcinoembryonic antigen (CEA), nuclear DNA ploidy, and proliferating cell nuclear antigen labeling index (PCNA LI) have been studied for their effect on patients with various types of cancer.

METHODS

Thirteen clinicopathologic variables, preoperative serum CEA levels, PCNA LI, DNA ploidy patterns, and survival were studied for 57 colorectal carcinoma patients, and the mutual relation between these variables, tumor progression, and survival were analyzed.

RESULTS

Seven variable including undifferentiated adenocarcinoma, deep invasion, lymphatic and venous invasion, node metastasis, liver metastasis, and advanced stages were significantly greater for patients with positive CEA ( > 5.0 ng/mL) than for patients with negative CEA ( < 5.0 ng/ML). Three variables including deep invasion, liver metastasis, and advanced stages were significantly greater for patients with high PCNA LI ( > 49.4%) than for patients with low PCNA LI ( < 49.4%). No significant difference was observed in any of the variable for patients with DNA diploid or aneuploid cancer. A close relationship representing a formula, Y (log CEA, ng/mL) = 0.026X (PCNA LI, %) - 0.478, was found between CEA level and PCNA LI: Survival curves for patients with negative CEA and low PCNA LI were significantly greater than those for patients with positive CEA and high PCNA LI: Survival curves were significantly greater for patients with positive CEA and low PCNA LI than for patients with positive CEA and high PCNA LI: However, no significant difference was observed in the survival curves of patients with different DNA ploidy patterns.

CONCLUSIONS

Serum CEA and PCNA LI for cancer patients is useful in the evaluation of tumor progression and in prognosis. Analysis of DNA ploidy appears to be unavailable for this evaluation.

[Quantitative flow measurement of the vertebro-basilar circulation for positional vertigo by using 2D phase contrast technique]

Quantitative measurements of blood flow in the vertebral and basilar arteries were obtained by the 2D phase contrast (2D PC) technique. In phantom study, flow velocity measured with 2D PC correlated well with actual flow velocity. Sixty-six patients were neurologically normal and 20 had positional vertigo due to vertebrobasilar insufficiency (VBI). Mean velocities (MV) were measured by using a transverse plane in the vertebral arteries at the level of C3 and in the basilar arteries at the level of the sella floor. Volume flow rates (VFR) were calculated as the product of MV and the area of the arteries whose diameters were measured on the basis of pixel counting in the histogram of the signal intensity profile. In the normal group, MV of the left vertebral artery and MV and VFR of the basilar artery showed significant declines as age progressed. In the vertigo group, MV and VFR of the basilar artery were significantly lower than in the normal group. It is concluded that 2D PC technique appears to be fast and easy to handle without cardiac gating to assess blood flow in vessels surrounded by bone tissues.

Biochemical bases in differentiation of a mouse cell line GSM06 to gastric surface cells

A mouse gastric surface cell line GSM06 established from a transgenic mouse harboring temperature-sensitive simian virus 40 large T-antigen gene was subjected to the lipid and glycoprotein analysis. When GSM06 cells were cultured for a long time after formation of a confluent monolayer, they differentiated to resemble foveolar epithelial cells morphologically. Biochemical changes during culture were studied in cells harvested just when a monolayer had formed (day 0), on day 7, and on day 21. Content of total phospholipids, cholesterol, cholesterol sulfate, total sugar and sialic acid increased about 1.5-fold from day 0 to 7 and remained elevated till day 21. The fatty acid composition of phospholipids revealed increased relative levels of oleic acid in phosphatidylcholine and phosphatidylethanolamine, and an increased level of plasmenylethanolamine from day 0 to 7. The level of dolichylphosphate continued to increase in a time-dependent manner. Glycosylation of various proteins, detected with lectins, was enhanced from day 7. In addition, greater resistance to taurodeoxycholate and acetylsalicylic acid was observed on days 7 and 21 than on day 0. Thus, enhanced glycosylation of proteins and an overall increase in the area of cellular membranes were the major changes in GSM06 cells during culture, and they were accompanied by an enhancement of cytoprotective potential.

Biological characterization of gastric surface mucous cell line GSM06 from transgenic mice harboring temperature-sensitive simian virus 40 large T-antigen gene

We investigated the biological features of gastric surface mucous cell line GSM06, established from transgenic mice harboring the temperature-sensitive simian virus 40 large T-antigen gene. GSM06 cells grew until confluent monolayers were formed at the permissive temperature (33 degrees C), showing that the cessation of cell growth may be due to contact inhibition. Moreover, the cells did not grow in a soft agar gel. However, chromosome numbers of the cells were not normal. When GSM06 cells were cultured in Daigo's T medium supplemented with growth factors and 10% fetal bovine serum at 33 degrees C for 1, 3 or 9 days, the cells gradually grew to confluent monolayers (day 9). Morphological observations revealed that the cells time-dependently formed microvilli-like structures and yielded periodic acid-Schiff-positive glycoproteins on the cell surface with the growth of the structures. When GSM06 cells were cultured on a membrane filter for 1-9 days, elevated transepithelial resistance was noted in a culture period-dependent fashion. On day 9, junctional complexes such as tight junctions and desmosomes were observed between the cells. In addition, prostaglandin E2 production was evoked from the cells from day 1. In order to determine cell viability, GSM06 cells were labeled with the fluorescence dye 2',7'-bis(carboxyethyl)-carboxyfluorescein. Exposure of GSM06 cells to ethanol (7.5-17.5%) elicited cell injuries in a concentration-related manner on day 1, whereas these cytotoxic effects were attenuated on days 3 and 9, suggesting that this protection may be, at least in part, related to the increased glycoproteins and transepithelial resistance. GSM06 cells possessing these unique characteristics should be highly useful as an in vitro model of gastric epithelium.

[Minimizing of the blood preparation for elective surgery by maximum surgical blood order schedule as well as type and screen--two year's experience in Nagahama City Hospital]

To make the most of the blood products, we have introduced maximum surgical blood order schedule (MSBOS) as well as Type and Screen (T&S) into Nagahama City Hospital. As the hospital dose not have blood transfusion service unit, we, anesthesiologists set up MSBOS and the procedure of blood preparations for elective surgery. The results of two year's experience demonstrate that there was no trouble by reducing the blood preparation. The cross-match to transfusion ratio (C/T ratio) in surgical procedures and that of red cell products in our hospital have decreased, the effective use of red cell products has been promoted, and the outdating of the blood product has been reduced.

Analysis of proliferative activity using antiproliferating cell nuclear antigen antibody in colorectal cancer

Using anti-PCNA antibody (PC10), an immunohistochemical study of the expression of PCNA in formalin-fixed and paraffin-embedded materials of colorectal cancer patients was performed and correlation of PCNA expression with clinicopathological findings and DNA ploidy pattern was studied. PCNA labeling rate (PCNA LR) was estimated in the advancing margin of the tumor and ranged from 23.8% to 77.9%. There was a significant difference in lymphatic vessel invasion, liver metastasis and Dukes' stage between the groups with high (> 48.7) and low (< 48.7) PCNA LR (P < 0.05). No differences were seen in tumor size, histological type, lymph node metastasis or DNA ploidy pattern. In patients with younger age, infiltration to neighboring organs, a high degree of venous invasion, and peritoneal dissemination, the frequency of high PCNA LR tended to be higher (P < 0.1). The results above suggest that a high proliferative activity as defined by evaluation of the PCNA LR at the advancing margin of the tumor may be one of the parameters of malignant potential and helpful as a predictor of liver metastasis in colorectal cancer.