Treatment of small hepatocellular carcinoma

Of the 692 patients with hepatocellular carcinoma (HCC) who were admitted to our hospital between 1976 and 1990, 60 (8.8%) had small HCC with a maximal diameter of below 2 cm. The outcome of these 60 cases was analyzed after they had been divided into 4 groups based on the therapeutic method used: operation group (17 cases), percutaneous ethanol injection therapy (PEIT) group (20 cases), transcatheter arterial embolization (TAE) group (13 cases), and oral anticancer drug therapy (per os) group (10 cases). The 1-, 2-, 3-, 4-, and 5-year survival values obtained for the operation group (100%, 87.5%, 87.5%, 87.5%, and 87.5%, respectively) were significantly higher than those found for the per os group (P < 0.01). The best therapeutic results were achieved in the operation group. Although the follow-up period for the PEIT group was short, the 2-year survival of this group was nearly equal to that of the operation group. Whereas the duration of survival tended to increase in inverse proportion to the severity of the underlying liver cirrhosis, the survival values did not differ between solitary and multiple tumors or among the different histological grades of HCC. In this series, 20 patients died; 9 deaths (45.0%) were due to progressive disease and 3 deaths (15.0%) were attributed to hepatic failure. Because the operation group included many patients who displayed relatively good liver function, we cannot rule out the possibility that their excellent outcome may have been associated with this background factor. Therefore, further prospective investigation is necessary to compare the efficacy of various therapies in patient groups with a homogeneous background.

Network system: the integrated picture archiving and communication system with the hospital information system

We describe the outline of Hokkaido University picture archiving and communication system (HU-PACS) and its network functions. HU-PACS processes 0.5 Gbytes of images daily through 10 acquisition devices. Functional integration of hospital information system (HIS) and PACS has been implemented. The HU-PACS can access common data base with HIS. Multi-image data-base systems provide fast throughput of image retrieval. The system is composed of 4 modules: (1) 2 image data-base systems (IDS), (2) 1 image management system (IMS), (3) image display terminals (IDT), and (4) 8 image acquisition nodes interfaced to 10 modalities and 1 film scanner. These 4 modules are connected by branch and loop type local area networks (LAN). HU-PACS has functions other than basic PACS functions. Images in optical disk library (ODL) are loaded onto magnetic disks (MD) in advance according to patient booking information, the images expected to be viewed are transferred to the local storage automatically, and the desired images can be pre-downloaded into local storage by instruction through HIS terminals.

Acute mesenteric lymphadenitis due to Yersinia pseudotuberculosis lacking a virulence plasmid

A serotype 4a strain of Yersinia pseudotuberculosis lacking the virulence plasmid pYV (pYV- strain) was isolated from the mesenteric lymph nodes but not from the stool or the appendix of a 10-year-old girl with a diagnosis of acute mesenteric lymphadenitis. Microscopically, reticulocytic abscess and lymphadenitis were persent in the enlarged mesenteric lymph nodes. Antibody against the isolate was detected in the serum. The isolate was negative for the presence of plasmid pYV and plasmid pYV-mediated properties, including autoagglutination and calcium dependency, but was positive for chromosome-mediated properties, including invasion into HeLa cells and tissues of mice and the Serény test. Mice were orally infected with this pYV- strain, and rapid elimination from the intestine occurred 14 days later. Hence, the potential to inhibit the phagocytosis encoded by plasmid pYV was lacking. As the pYV- strain was recovered from the mesenteric lymph nodes and the spleen, the invasiveness was encoded by chromosomal genes. The count of the pYV- strain in the mesenteric lymph nodes increased to 10(4.6) cells per g within 4 days. These findings suggest that pYV- Y. pseudotuberculosis was the causative agent of acute mesenteric lymphadenitis in the absence of gastroenteritis.

Antiplatelet glycoprotein Ib monoclonal antibody (OP-F1) totally abolishes ristocetin-induced von Willebrand factor binding, but has minimal effect on the botrocetin-induced binding

We describe here a new antiplatelet glycoprotein (GP) Ib monoclonal antibody (MoAb) designated OP-F1 (IgG1 kappa). Both OP-F1 and a well-characterized anti-GPIb MoAb, AP-1, totally abolished ristocetin-induced von Willebrand factor (vWF) binding to platelets and desialylated vWF binding to platelets at an IgG concentration of 2-8 micrograms/ml. AP-1 also blocked snake venom botrocetin-induced vWF binding at a similar IgG concentration, whereas OP-F1 had a minimal effect on botrocetin-induced binding. At a higher IgG concentration (150 micrograms/ml), OP-F1 inhibited botrocetin-induced binding by 50%. AP-1 (IgG) did not interfere with binding of [125I]OP-F1 (IgG) to platelets. Thus, the epitope involved in the binding of OP-F1 or AP-1 appears to be quite different. These results suggest that the vWF binding site(s) on the GPIb molecule generated by these inducers is in close proximity but not completely identical.

[A basal cell carcinoma of the esophagus--a case report]

Reported is the case of a 58-year-old male who visited our hospital with the chief complaint of anorexia. Diagnosed as having an esophageal cancer, a subtotal esophagectomy was performed including the dissection of the tumor. According to the surgical findings, the tumor was not exposed to the tunica externa and no lymph node metastasis or infiltration to the pleura or a metastasis to the lung or liver was note. On histopathological examination a basal cell carcinoma of esophagus was determined but no squamous epithelium was seen. The carcinoma was the muscular propria, and neither infiltration into the epithelium nor invasion into the vessels was noted. The postoperative progress appeared good, however seven months later the patient died from multiple hepatic metastasis.

[Changes in ketone body ratio and levels of pyruvate and lactate in arterial blood of patients with hepatocellular carcinoma after transcatheter arterial embolization]

The ketone body ratio (acetoacetate/3-hydroxybutyrate:KBR) and levels of pyruvate and lactate in arterial blood of patients with hepatocellular carcinoma (HCC) were examined. KBRs and levels of pyruvate and lactate in patients with HCC were similar to those in patients without liver diseases (1.57 +/- 0.88, 0.84 +/- 0.32, 11.4 +/- 4.5 vs 1.80 +/- 0.9, 0.89 +/- 0.48, 10.8 +/- 6.2). However, pyruvate to lactate ratios were significantly lower in HCC patients (7.45 +/- 1.57 vs 8.62 +/- 2.15, p less than 0.05). Among the HCC patients the levels of pyruvate and lactate were significantly higher in patients with liver cirrhosis (LC) than those in patients without LC. The sequential changes of KBRs and levels of pyruvate and lactate were examined before and after transcatheter arterial embolization (TAE). Although KBRs were transiently decreased immediately after TAE, they were at higher levels from the 3rd to 21st day in comparison with those before TAE. The levels of pyruvate and lactate showed no significant changes immediately after TAE. However, they followed a course similar to that of KBRs after TAE. Lower KBRs and higher levels of pyruvate and lactate tended to be observed in HCC patients with LC after TAE than in those without LC. This suggests a decrease of intrahepatic blood flow probably due to histological reconstruction. These results suggest that the presence of LC is one of the most important factors influencing the functional reserve of liver in HCC patients. In HCC patients without LC, the recovery from the overload of TAE may operate at mitochondrial levels at least the 3rd day after TAE.

[Ultramicroassay of red cell group using Terasaki-plate]

In order to simplify the testing-method of blood groups (ABO, Rh, MN, Ss, P, I, Lewis, Duffy, Kidd and Diego) and the assay of glycosyl transferases activity, we have developed a new method using Terasaki plate (T-plate method), and examined its usefulness in the routine examination. As results followings were obtained: 1) The sensitivity of T-plate method was equal or superior than that of the common method using test-tube. 2) Samples used for T-plate method were smaller in volume compared with those for the common tube test method. 3) The percent of coincidence between T-plate method and tube test method was 100% for ABO, Rh, MN, Ss, P, I, Duffy, Kidd and Diego grouping. They were 98% for Lewis(a) and 96% for Lewis(b) grouping, respectively. These results indicate the superiority of T-plate method than the common method using test-tubes in respects of smaller volume of samples, lower price and handling of a large amount of samples.

[Basic and clinical evaluation of an immunoradiometric competitive inhibition assay for sialyl Tn antigen: (1). Evaluation of assay conditions and normal values. STN Study Group]

An immunoradiometric competitive inhibition assay of the serum levels of the sialyl Tn antigen using "STN Otsuka" kits is described. The assay required only duplicate 50-microliters samples, and the concentration of sialyl Tn antigen in serum was determined by reference to a standard curve ranging from 0 to 400 arbitrary units/ml. The intra-and inter-assay reproducibilities were largely satisfactory. The serum levels of the antigen in normal individuals were not affected by ABO and Lewis blood type status of the tested individuals. Normal values were 25.5 +/- 9.8 in male, and 21.3 +/- 8.0 in female, and the difference was statistically significant at p less than 0.001. The serum level of the antigen was not affected by menstrual cycle or pregnancy in female, whereas the level of other tumor markers such as CA 125 was highly variable depending upon these conditions.

[Basic and clinical evaluation of an immunoradiometric competitive inhibition assay for sialyl TN antigen: (2). Evaluation of clinical significance. STN Study Group]

The clinical significance of serum sialyl Tn antigen as a tumor marker was evaluated using "STN Otsuka" kits. Results indicated that the antigen was frequently elevated in sera from patients with ovarian cancers (43.1%, 140/325), including serous cystadenocarcinoma (51.6%, 63/122), mucinous cystadenocarcinoma (55.6%, 30/54), endometrioid carcinoma (56.5%, 13/23), and mesonephroid carcinoma (40.0%, 6/15). The positive frequency of sialyl Tn antigen in patients with ovarian carcinoma was less than the frequency of CA 125 (75.5%, 194/257) or sialyl SSEA-1 (47.2% 83/176). However, the false positive rate of sialyl Tn antigen in patients with benign gynecological disorders (3.7%, 15/401) was much lower than the false positive rates of other antigens; such as CA 125 (48.4%, 155/320) and sialyl SSEA-1 (19.2%, 51/266). The serum level of sialyl Tn antigen reflected the clinical activity of the disease quite well in patients with ovarian cancers. The sialyl Tn antigen was concluded to be a useful serum tumor marker for ovarian cancers.

Two familial cases of Jordans' anomaly. Ultrastructural studies and the development of fat-containing vacuoles in the neutrophilic series

A study was conducted on two brothers with Jordans' anomaly. Fat-containing vacuoles were noticed in all leukocytes of the peripheral blood and cells of the myeloid series including myeloblasts, but the serum lipids showed no abnormalities. However, cells of the erythroid series, megakaryocytes and platelets did not contain these vacuoles. An increase in vacuole number was observed as the leukocytes matured. Histochemically, it was suggested that these vacuoles contained neutral fat based on staining with Sudan III and Nile blue sulfate. Ultrastructurally, these vacuoles were unassociated with lysosomes or other cell organelles. Although the etiology of Jordans' anomaly could not be clarified by this study, genetic factors may be involved.

[Combination chemotherapy including cisplatin in lung cancer by bronchial artery infusion]

Chemotherapy with bronchial artery infusion (BAI) was given to 34 patients with primary lung cancer. Treatment regimens usually employed cis-diammine-dichloroplatinum (CDDP) plus peplomycin for squamous cell carcinoma, and CDDP plus vindesine for adenocarcinoma. The provisional therapeutic effects were evaluated roentgenographically with reference to histological type, T factor and degree of vascularization. Out of 10 cases of squamous cell carcinoma, 7 cases (70%) showed tumor regression greater than 50%, in contrast to 4 of 17 cases (23.5%) of adenocarcinoma. The effects in cases of squamous cell carcinoma were correlated with tumor vascularity. Twenty-two surgically treated cases were examined for the histological effects of BAI. Five of 6 cases (83.3%) of squamous cell carcinoma showed IIb effects by Shimosato's criteria. These results showed that the therapeutic effect of BAI was excellent in cases of squamous cell carcinoma in comparison with cases of adenocarcinoma. Serious side effects including esophago-bronchial fistula, massive hemoptysis and esophageal ulcer were observed in 4 cases.

[An immunohistochemical study using a double staining method for regional lymph nodes in gastric cancer]

We have performed a double immunofluorescent staining of two monoclonal antibodies, obtained from gastric cancer patients, that were directed against lymphocyte surface antigens on the regional lymph nodes. Through this method we were able to identify the lymphoid cell subset in detail. As a result of our double staining, most OKT8+ lymphocytes were also found to be Leu 15- lymphocytes and these OKT8+ Leu 15- lymphocytes were regarded as being cytotoxic effector cells or precursors. A few OKT8+ Leu 15+ lymphocytes (suppressor T lymphocytes) were obtained. More Leu 3a+ Leu 8- lymphocytes (helper T lymphocytes) were observed than Leu 3a+ Leu 8- lymphocytes (suppressor inducer T lymphocytes). To investigate whether these T lymphocytes were activated, we used an OKT 9 monoclonal antibody directed against the transferrin receptor and an OKIa1 monoclonal antibody directed against the HLA-DR framework. Such double stained lymphocytes (activated T lymphocytes) were few.

Adverse affect of blood transfusions on survival of patients with gastric cancer

The effect of perioperative blood transfusions on the survival rate of patients with gastric cancer was studied. The survival rate of the transfusion group was significantly lower than that of the nontransfusion group in each of the 5 postoperative years. When no adjuvant immunochemotherapy was performed postoperatively, the prognosis was definitely worse in the transfusion group than in the nontransfusion group. Furthermore, the survival rate of the transfusion group was lower than that of the nontransfusion group in both histopathologic classifications of gastric cancer, and it was lower to a statistically significant extent among the well-differentiated types. These results indicate that transfusions might adversely affect postoperative survival of patients with gastric cancer.

Analysis of tissue lymphocytes by double fluorescent staining--gastric cancer tissue and regional lymph nodes

An immunohistochemical study was performed on human lymphocytes in the tissue of gastric cancer, and also in the regional lymph nodes, by double fluorescent staining, using monoclonal antibodies. Leu3a+8+ cells (inducer T cells) which consist about 30 per cent of Leu 3a+ cells were seen in the tissue surrounding the gastric cancer. The other 70 per cent of Leu 3a+ cells were Leu3a+8- cells (helper T cells). In the lymph nodes they were noted in T cell areas in almost the same proportions, while in germinal centers, only Leu3a+8- cells were found. On the other hand, OKT8+Leu15- cells (cytotoxic T cells) were noted in a large number, while OKT8+Leu15+ cells (suppressor T cells) were few. Further, an increase of OKT8+Leu15- cells was seen around gastric cancer or metastatic cancer in lymph nodes. These immunohistochemical findings suggest that cytotoxic T cells are the main component in the tissue of gastric cancers and the regional lymph nodes. Increases in inducer T cells and helper T cells are probably required to induce cytotoxic T cells around the cancer tissue.

Metaplastic bone formation in a hyperplastic polyp of the stomach: a case report

Metaplastic bony tissue along with hyperplastic mucosal epithelium showing no atypism was detected in biopsy materials from a Yamada type I gastric polyp. The tissue was metaplastic woven bone associated with calcification. Histogenesis of the bone formation is as yet unknown. This is the first reported case of the presence of metaplastic bone accompanied by hyperplastic gastric mucosa so far.

Noninvasive measurement of baroreflex sensitivity index using an indirect and continuous blood-pressure recorder

The index of the baroreceptor reflex sensitivity (BRS) was measured noninvasively by monitoring the arterial pressure (AP) of the finger and R-R interval on the ECG during a Valsalva maneuver. An indirect finger AP measurement system was newly designed on the basis of the so-called vascular unloading technique. The BRS index was determined as the slope of the linear regression equation between the R-R interval and the virtual brachial AP which was evaluated from the finger AP. The data on both parameters were taken from the second period of the fourth phase in the Valsalva maneuver. The measurement was carried out on 24 inpatients (29-65 years) with essential hypertension. The conventional invasive method using phenylephrine or nitroglycerine was also performed on the same subjects. The correlation coefficient between the invasive and noninvasive methods was 0.81 when phenylephrine was used and 0.90 with nitroglycerine (p less than 0.001). The present method was found useful in routine clinical examination because of its easy and repeatable noninvasive application to patients without causing stress.