A case of hepatocellular carcinoma with marked hyperfibrinogenemia

The present report concerns a case of hepatocellular carcinoma (HCC) with marked hyperfibrinogenemia. The plasma fibrinogen level reached as high as 1,704 mg/dl. Since treatment against HCC resulted in reduction of plasma fibrinogen and PIVKA-II, an HCC marker, the hyperfibrinogenemia appears to be related to HCC. Immunohistochemically, the HCC specimen from this patient reacted strongly with antiserum to human fibrinogen, suggesting that the elevated fibrinogen was due to synthesis of this protein by the carcinoma cells, not to decreased fibrinolytic activity.

lpr T cells have lower ability to maintain bcl-2 expression ex vivo

Autoimmune-prone lpr mice develop lymphoproliferative disorders, whereas their lymphocytes show accelerated apoptosis in culture. To elucidate whether the bcl-2 protein, a repressor of apoptosis, is critical to the discrepancy between in vivo and in vitro survival, we examined bcl-2 expression in T cells from +/+ and lpr mice during culture. The expression levels of bcl-2 in cultured T cells from lpr mice were significantly down-modulated compared to those from +/+ mice and freshly obtained T cells. Besides, the reduction of bcl-2 protein levels was inhibited in T cells cultured in the presence of T cell receptor (TCR) signalling. These results suggest that lpr T cells might be susceptible to apoptosis in vitro due to down-modulation of bcl-2 by withdrawal of TCR signalling.

Establishment of a sandwich enzyme linked immunosorbent assay for canine interleukin-8

To estimate canine interleukin-8 (cIL-8) levels in blood plasma samples, a sandwich enzyme linked immunosorbent assay (ELISA) was established. For the development of the sandwich ELISA, polyclonal anti-cIL-8 (capturing), biotinylated anti-cIL-8 (developing) antibodies and glutathione-S-transferase/cIL-8 (GST/cIL-8) fusion protein as an antigen were used. cIL-8 in the fusion protein of GST/cIL-8 was detected in a dose dependent manner. The lowest limit of GST/cIL-8 detectable by this method was 2 ng/ml of GST/cIL-8 (containing; 0.470 ng/ml of cIL-8). IL-8 levels in the plasma samples from apparently healthy dogs were less than 0.470 ng/ ml. Higher levels of IL-8 were detected in the plasma samples of dogs with cystitis, dermatitis, and gastric cancer. These results suggest that the determination of cIL-8 by the sandwich ELISA is useful in diagnosis of inflammatory diseases in dogs.

Association of eosinophil granule major basic protein with atopic cataract

PURPOSE

To investigate the mechanism of atopic cataract development, we examined a tissue-destroying major basic protein, derived from eosinophils, in the anterior capsule of cataractous lenses and the aqueous fluid of atopic dermatitis patients.

METHODS

Major basic protein deposition in anterior capsule tissues was evaluated immunohistochemically using anti-major basic protein monoclonal antibody in three consecutive eyes from three atopic cataract patients and three consecutive eyes from three senile cataract patients. Also, major basic protein concentration in aqueous fluid obtained during cataract surgery was measured by radioimmunoassay in 12 consecutive eyes from 11 atopic cataract patients and 15 consecutive eyes from 15 senile cataract patients.

RESULTS

Immunohistochemical investigation demonstrated lens epithelial major basic protein deposition in all three atopic cataracts but not in any of the senile cataracts. Major basic protein was detected in the aqueous fluid by radioimmunoassay in four of the 12 atopic cataract eyes and ranged in concentration from 11 to 70 ng/ml. No major basic protein was detected in the aqueous fluid of the 15 senile cataract eyes.

CONCLUSION

Major basic protein in anterior capsule tissues and in the aqueous fluid of eyes with atopic cataract may be associated with the pathogenesis of atopic cataract.

Dynamics of soluble adhesion molecule levels in patients with pollinosis

OBJECTIVES

To define the dynamics of systemic and local soluble adhesion molecule levels and to discuss the role of these molecules in the pathogenesis of allergic rhinitis.

DESIGN

Randomized control trial.

SUBJECTS

Twelve volunteers with Japanese cedar pollinosis and 7 healthy volunteers.

INTERVENTIONS

The levels of soluble intercellular adhesion molecule 1 (sICAM-1), soluble vascular cell adhesion molecule 1 (sVCAM-1), soluble E-selectin, and soluble L-selectin in serum samples and nasal epithelial lining fluids (ELF) from 12 patients with pollinosis were measured 5 times throughout the allergy preseason to postseason, and the results were compared with those from 7 healthy subjects.

RESULTS

The levels of sICAM-1 (P < .05) and sVCAM-1 (P < .05) in sera were up-regulated, and the levels of soluble L-selectin (P < .01) in sera were down-regulated during the early stage of the season in the allergic subjects. The difference between the levels of sICAM-1 and sVCAM-1 in sera in the early and mid-season was statistically significant in the allergic subjects (P < .05). The levels of sICAM-1 in ELF were up-regulated during the early and mid-season. The levels of sVCAM-1, soluble E-selectin, and soluble L-selectin in ELF were undetectably low throughout the preseason to postseason.

CONCLUSION

There is evidence of the unique stage-dependent differential contributions of various soluble adhesion molecules in the pathogenesis of seasonal allergic rhinitis with a small amount of natural allergen provocation.

Successful endoscopic balloon dilatation for hypertrophic pyloric stenosis

The authors successfully applied endoscopic balloon dilatation for the treatment of hypertrophic pyloric stenosis (HPS). The patient was an infant girl who had undergone repair of a giant omphalocele. Endoscopic balloon dilatation was performed using a 9-mm endoscope and an 8-mm polyethylene terephthalate (PET) balloon dilator. Dilatation was performed three times for 10 minutes. Vomiting continued after the dilatation. At the second session, dilatation was performed using a 12-mm PET balloon dilator. The 9-mm endoscope then passed through the pylorus. The patient has had no episodes of vomiting since the second treatment. This procedure is an important therapeutic option for selected patients with HPS.

Membrane knobs of unfixed Plasmodium falciparum infected erythrocytes: new findings as revealed by atomic force microscopy and surface potential spectroscopy

Cerebral malaria, a severe complication of malaria, is caused by the obstruction of cerebral microvessels by Plasmodium falciparum-infected erythrocytes. Such cells adhere to endothelial cells by means of "knobs" induced on the red cell membrane by the parasites. When atomic force microscopy was used to investigate the structure of the knobs of unfixed infected red cells, each knob was found to consist of two distinct subunits, knob components that have never been seen in chemically fixed knobs examined by conventional transmission electron microscopy. Surface potential spectroscopy revealed that the knobs have a positive charge (+20 mV), whereas the remainder of the red cell plasma membrane is negatively charged. Since endothelial plasma membranes have a negative charge, the charge difference between knobs and endothelium may play a significant role in cytoadherence between the two cell types. The subunit structure of the knobs may be a steric necessity to align adherence molecules so that they can exert their effect. This study shows that the atomic force microscope has great potential for examination of cells in their native state; in combination with surface potential spectroscopy, it may uncover fundamental processes and mechanisms in cell function.

GB virus C/hepatitis G virus infection among Japanese patients with chronic liver diseases and blood donors

Recently, a novel hepatitis virus, GB virus C/hepatitis G virus (GBV-C/HGV), has been isolated. To elucidate the seroprevalence of chronic GBV-C/HGV infection in Japan and the phylogenetic relationship between Japanese strains and the strains previously reported, serum GBV-C/HGV RNA was detected by reverse transcription polymerase chain reaction (RT-PCR) in 203 patients with chronic liver diseases and 200 samples of voluntary blood donors. RT-PCR was performed with primers derived from the 5'-untranslated region which were conserved between GBV-C and HGV and distant from other flaviviruses including hepatitis C virus (HCV). The nucleotide sequences were determined by the dideoxy chain termination method. The phylogenetic analysis was performed by the neighbor-joining method. In 10 (4.7%) of 203 patients with chronic liver diseases and in 1 (0.5%) of 200 blood donor samples, serum GBV-C/HGV RNA was detected. Of 10 patients, 9 patients were positive for anti-HCV and negative for HBsAg, and 1 patient was positive for HBsAg and negative for anti-HCV. The phylogenetic analysis indicated that there were three major groups which were group 1 (GBV-C), group 2 (HGV), and group 3 (a group of Japanese strains). These data indicated that (1) there was a low prevalence of GBV-C/HGV infection in Japanese patients with chronic liver diseases, (2) a high proportion of patients with GBV-C/HGV infection had chronic HCV infection however, and (3) there were at least three groups in strains of GBV-C/HGV.

Apoptosis by CD95 (Fas)-dependent and -independent mechanisms in Peyer's patch lymphocytes in murine retrovirus-induced immunodeficiency syndrome

CD95 (Fas)/CD95 ligand (CD95 L)-mediated apoptosis is thought to be involved in the delayed progression of murine AIDS (MAIDS) induced by LP-BM5 murine leukemia virus (MuLV). We show evidence of apoptosis in lymphocytes of Peyer's patches (PP) at the early stage of MAIDS. Both T and B cells in PP expressed CD95 at the early stage of MAIDS and decreased in number thereafter. The decrease in T cells was not evident in CD95-mutated lpr mice with MAIDS, suggesting that CD95/CD95 L interaction is involved in the apoptosis of T cells in PP during the course of MAIDS. On the other hand, the number of B cells was also decreased in PP of lpr mice with MAIDS. The proliferative ability of B cells in PP of MAIDS mice in response to immunoglobulin M cross-linking or lipopolysaccharide was severely impaired, while the B cells normally proliferated in response to anti-CD40 monoclonal antibody. These findings imply that aberrantly activated B cells in PP undergo apoptosis independently of the CD95/CD95 L system during the course of infection with MAIDS virus.

Feasibility of effect-controlled clinical trials of drugs with pharmacodynamic hysteresis using sparse data

PURPOSE

To explore, by simulation procedures, the feasibility of characterizing, from sparse data, the concentration-effect relationship of drugs with pharmacodynamic hysteresis.

METHODS

For computer simulations, the concentration-effect relationship was assumed to be describable by the Sigmoid-Emax equation, the site of drug action was located in a distinct effect compartment (keo = 10 x kelim), and the pharmacokinetics were those of either a linear one- or two-compartment system. In view of the poor estimability of the parameters of the Sigmoid-Emax model under the usual clinical conditions, central compartment post-distributive drug concentrations required to elicit various intensities of effect within the therapeutic range were used as data descriptors. Effect intensities of 5 and 25, or 25 and 50 units (with the "unknown" Emax = 100 units) were targeted in multiple-dose (steady state) trial designs. From these data, drug concentrations required to produce effect intensities of 15 and 50 units were estimated by both log-linear and linear interpolation and the actual effect intensities produced by these concentrations were calculated. These simulations were performed over a wide range of Hill coefficient values (0.5 to 4.0) and dosing intervals (0.1 to 1.5 x elimination t1/2.

RESULTS

Acceptable results could be obtained by measuring drug concentrations and effect intensities at or near the end of a dosing interval. The largest deviations of effective concentration estimates (in terms of effect intensity) occurred at a Hill coefficient value of 0.5 and the results were very little affected by changing the dosing interval.

CONCLUSIONS

Our results demonstrate that effect-controlled clinical trials, with sparse data, of drugs with pharmacodynamic hysteresis for determining concentration-effect relationship in the therapeutic range are feasible in principle.

[Specific inhibitory effect of hybrid liposomes on the growth of hybridoma cells in vitro]

Remarkably high inhibitory effects of the hybrid liposomes composed of L-alpha-dimyristoyl-phosphatidylcholine (DMPC) and polyoxyethylenealkyl ether (C14(EO)n, n = 6-8 and C12(EO)n, n = 8-12)) on the growth of human lymphoma-human B-lymphocyte hybridoma (HF) cells in vitro were obtained. The hybrid liposomes composed of 90 mol% DMPC/10 mol% C14(EO)n (n = 6-8) or C12(EO)n (n = 8-12) were more fluid as compared with 90 mol% DMPC/10 mol% C14(EO)4 or C12(EO)n (n = 4, 23) hybrid liposomes on the basis of fluorescence polarization measurements. These results suggest that the inhibitory effects of the hybrid liposomes on the growth of HF cells should be related to the membrane fluidity. No toxicity to normal rats in vivo was observed in the experiment using 90 mol% DMPC/10 mol% C14(EO)7 or 90 mol% DMPC/10 mol% C12(EO)12 hybrid liposomes.

Miscoding properties of 3,N4-etheno-2'-deoxycytidine in reactions catalyzed by mammalian DNA polymerases

We have investigated the miscoding properties of the exocyclic DNA adduct, 3,N4-etheno-2'-deoxycytidine (epsilon dC), using an experimental system designed to detect and quantify base substitutions and deletions generated by primer extension in reactions catalyzed by DNA polymerases alpha, beta, and delta. Oligodeoxynucleotides modified site-specifically with epsilon dC were used as DNA templates for this study. Pol alpha catalyzed incorporation of dTMP and dAMP opposite epsilon dC, accompanied by lesser amounts of dCMP and dGMP and some two-base deletions. Pol beta promoted incorporation of dCMP and dAMP, along with small amounts of one-base and two-base deletions. Pol delta catalyzed incorporation of dTMP and lesser amounts of dAMP and dGMP. The frequency of nucleotide insertion opposite epsilon dC and of chain extension from the 3'-primer terminus in reactions catalyzed by pol alpha and pol beta was established by steady-state kinetic analysis. Results of this study were consistent with those obtained in primer extension experiments. The miscoding properties of epsilon dC determined in vitro are consistent with observations of epsilon dC-->A transversions and epsilon dC-->T transitions in site-specific mutagenesis experiments in mammalian cells (Moriya et al. (1994) Proc. Natl. Acad. Sci. U.S.A. 91, 11899). We conclude from this study that DNA polymerases may differ significantly in their miscoding potential and that in vitro analysis can be used to predict mutagenic specificity of exocyclic DNA adducts in mammalian cells.

Characterization of epileptiform field potentials recorded in the in vitro perirhinal cortex of amygdala-kindled epileptogenesis

The perirhinal cortex (PRC) has recently been reported that the excitatory role of this area is important for the generation and the propagation of kindled seizures. In the present study, we investigated the extracellular electrophysiological properties of the circuitry which contribute to the propagation of seizures in the PRC, and examined the hypothesis that amygdala-kindling changes the electrophysiological nature of the rat PRC slice in vitro. Field potentials elicited in the PRC had extended duration (> 200 ms, most approximately equal to 1 s) with overlying spike components. The potentials showed strong synchronizing effect governed by an all-or-none rule. Although spontaneous epileptiform discharges that were equivalent in appearance to synaptically-activated field potentials were observed in the PRC of both amygdala-kindled and control rats, the number of slices showing spontaneous activity was significantly larger in the kindled group than in the control group (chi 2-test, P < 0.01). The occurrence of tetanus-induced afterdischarges in kindled rats was significantly higher than in control rats (chi 2-test, P < 0.01). The afterdischarge durations of control slices were generally short and the afterdischarges did not consist of the typical "tonic-clonic' phases. However, the occurrence of the electrographical seizure in the high K+ ACSF were not affected by amygdala-kindling operation. These results indicate that amygdala-kindling lowers the threshold for transsynaptic excitability and enhances the synchronized activity of the PRC induced by episodic proconvulsive manipulations such as tetanus stimulation.

Endoscopic ultrasonography of superficial esophageal cancers using a thin ultrasound probe system equipped with switchable radial and linear scanning modes

BACKGROUND

Detailed information on the depth of invasion of superficial esophageal cancer is required for endoscopic mucosal resection. As a pretherapeutic diagnostic procedure, endoscopic ultrasonography using conventional 7.5 MHz systems has been ineffective at providing sufficient details. A newly developed, thin ultrasound probe system provides both radial and linear scanning for evaluation of superficial esophageal cancer.

METHODS

Endoscopic ultrasonography was performed in 16 patients using a switchable probe driven at 20 MHz. Seventeen lesions of superficial esophageal cancer were evaluated for depth of invasion to discriminate mucosal from submucosal penetration.

RESULTS

The overall accuracy of staging was 64.7%. In all six errors, mucosal cancers were overstaged as submucosal invasion. The diagnostic accuracy was 80% when the muscularis mucosae was visualized.

CONCLUSION

A 20 MHz linear-radial switchable probe is a useful new method in the staging of superficial esophageal cancer.

Variation in serum creatine phosphokinase activity as indicated in two-phase EMC-D virus-induced myocarditis

In this study, myocardial damage in the D-variant of encephalomyocarditis (EMC-D) virus-induced myocarditis has been investigated consecutively by measuring serum creatine phosphokinase (CPK) activity. CPK activity in 8 week-old male BALB/cAJcl mice inoculated with EMC-D virus increased to a peak at 4 or 5 days postinoculation (DPI) and then gradually decreased. The CPK activity rose again after 7 DPI until it reached a second peak. In view of the kinetics of CPK activity, two-phase (early and late phase) myocardial damage in EMC virus infection were considered. In the late phase, an increase in cellular infiltration in the myocardium and a decrease in viral titer in the heart were observed. It was therefore suspected that the increase in CPK in the late phase may be caused by cellular infiltration, but not by viral replication. In our results, we suggested that a serial measurement of serum CPK activity might be a useful method for throwing more light on the myocardial damage caused by the autoimmune response. We also used a pathological (TUNEL) method to detect apoptotic cells and some apoptotic myocytes in the myocardium in late phase EMC virus-induced myocarditis.

Effects of dietary nucleoside-nucleotide mixture on memory in aged and young memory deficient mice

Intestinal mucosa, bone marrow hematopoietic cells and brain have limited capacity for the de novo synthesis of nucleosides (NSs) and nucleotides (NTs). Whereas the role of dietary NS and NT in the former two tissues is known, it is not known in the brain. Therefore we studied the effect of dietary NS and NT mixture on memory in aged mice (Experiment 1) and young memory deficient mice (Experiment 2). Memory retention was studied by step-through type passive avoidance performance (maximum 180 seconds). In Experiment 1 aged (7 month old) senescence accelerated mice (SAM) were fed 20% casein diet (control) or this diet supplemented with 0.5% NS/NT mixture for 12 weeks. Memory was studied 1, 2 and 3 days after the electric shock (punishment). In Experiment 2, young (1 month old) memory deficient mice (Dull mice) and normal mice (ddY mice) were fed the same diets as those in Experiment 1 for 12 weeks. Memory retention was studied 1 and 3 days after the punishment. In the aged SAM the average time of avoidance and also the percentages of successful memory 2 and 3 days after the punishment were significantly higher in the NS/NT diet group than the control diet group (P < 0.05). In the Dull mice percentage of successful memory was higher in the NS/NT diet group than in the control group 3 days after the punishment, however, such an effect was not observed in the normal mice. These results suggest that insufficient endogenous supply of NSs and NTs may be responsible for the factor of memory deficiency with aging or of genetical memory deficiency, which can be improved by the dietary administration of NSs and NTs.

Relationship between morphological diversity and AgNORs or cathepsin B expression in colorectal cancers

The biological characteristics associated with the morphological diversity of colorectal cancers were investigated to elucidate the causes of this diversity. We examined the proliferative and infiltrating activity of tumor cells, indicated by the mean number of Ag nucleolar organizer region associated proteins (NORs) per nucleus (MNA) and the immunohistochemical response to cathepsin B(CB), in various morphological types of early and advanced colorectal cancers. We examined 73 colorectal cancers obtained by endoscopic and surgical resection. MNA values for sessile and flat-elevated cancers were greater than the values for pedunculate, subpedunculate, and flat-or-depressed early cancers (sessile, P < 0.05). In advanced cancers invading the muscularis propria, protruding cancers showed significantly higher MNA values than small ulcerative cancers (P < 0.01). CB expression increased significantly with the progression of colorectal cancers (P < 0.01), but was not related to morphological diversity in early and advanced cancers. In both sessile and flat cancers, CB expression was higher in moderately differentiated than in well differentiated adenocarcinomas. These results indicate that, in colorectal cancers, protruding early cancers without stalks and protruding advanced cancers have higher proliferative activity than pedunculate or flat early cancers and small ulcerative advanced cancers, respectively, and that CB expression is not associated with morphological diversity, but with depth of invasion and histological differentiation.

Calcitonin gene-related peptide inhibits human platelet aggregation

Calcitonin gene-related peptide (CGRP) is a potent vasodilator in humans. CGRP receptors have also been found in various tissues other than blood vessels, such as the central nervous system, kidney, and heart. However, little is known about the effects of CGRP on human platelets. We investigated the effect of CGRP (human alpha type) on platelet aggregation in 21 healthy subjects (9 men and 12 women, mean age 54.6 years). CGRP inhibited platelet aggregation in vitro in 19 of the subjects (90.5%) in a dose-dependent manner with 50% inhibitory doses of 1.6 mumol/L and 1.1 mumol/L for aggregation induced by epinephrine and collagen, respectively. 125I-labeled CGRP bound specifically to intact platelets. The dissociation constant (Kd) was 61.9 +/- 17.7 pmol and the maximum number of binding sites (Bmax) was 5.4 +/- 3.9 pmol/10(9) platelets. The CGRP analogue (8-37)CGRP, but not calcitonin, inhibited the binding of 125I-CGRP to platelets. CGRP (5 mumol/L), but not (8-37)CGRP or calcitonin, increased the platelet cyclic AMP (cAMP) concentration by 31.7 +/- 3.6%. Thus, CGRP inhibits platelet aggregation via a specific receptor and by increasing the platelet cAMP concentration. CGRP may play a role in the modulation of platelet function in humans.

[Antimicrobial activity of cefodizime against clinical isolates]

In order to evaluate antimicrobial activity of cefodizime (CDZM), minimum inhibitory concentrations (MICs) of CDZM and control drugs were determined against clinical isolates collected from nation-wide medical institutions and in our laboratory from September to December of 1992 and from September to December of 1995. The results are summarized as follows: 1. Bacterial species with no or few strains resistant to CDZM included Streptococcus pyogenes, Haemophilus influenzae, Citrobacter koseri, Proteus mirabilis and Neisseria gonorrhoeae. The range of MIC values of CDZM against Klebsiella pneumoniae was spread. Other strains, Streptococcus pneumoniae, Moraxella subgenus Branhamella catarrhalis, Escherichia coli, Citrobacter freundii, Enterobacter spp., Serratia marcescens, Proteus vulgaris, Morganella morganii, Providencia spp., Peptostreptococcus spp. and Bacteroides fragilis group were resistant to cephems including CDZM. 2. The MIC90's of CDZM were 0.05 approximately 3.13 micrograms/ml against Streptococcus spp., H. influenzae, M. (B.) catarrhalis, E. coli, Klebsiella spp., P. mirabilis, N. gonorrhoeae and Peptostreptococcus spp. obtained in 1995 that were frequently found in daily treatment of infections. It appears that the effectiveness of CDZM was still relatively high against community-acquired infections. 3. Among H. influenzae isolates included imipenem (IPM)-resistant and norfloxacin (NFLX)-resistant strains. The MIC-range of CDZM against strains collected in 1995 including IPM-resistant and NFLX-resistant strains was < or = 0.025 approximately 0.1 microgram/ml, and MIC90 against these strains was 0.05 microgram/ml. CDZM showed strong antimicrobial activities against H. influenzae strains resistant to carbapenems and new-quinolones.

Expression profiles of active genes in human and mouse livers

An expression profile of active genes in the human liver was obtained by collecting sequences with a 3'-directed cDNA library that faithfully represents composition of the mRNA population. The results show the relative activity of ca. 600 genes in maintaining the hepatocytes and sustaining their liver-specific phenotypes. The most active group of genes are those for the production of plasma proteins, followed by the genes for the synthesis of lipoproteins, protease inhibitors, coagulation factors, and complements. This balance of gene activity was maintained for four independently obtained expression profiles from human livers, including those of adult and fetus. The expression profiling was extended to the liver of adult mouse, used as a model for the molecular etiology of hepatocytes and for examining the effects of drugs. Subtle biological differences between the human and mouse livers are reflected in the global expression profiles of active genes, especially with regard to the synthesis of plasma proteins, lipoproteins and complements. This comparative analysis using expression profiling should find a wide application in comparative biology.

[Intra-arterial infusion chemotherapy for breast cancer]

In order to reduce toxic effects while attaining maximal therapeutic effects, epirubicin 10 mg/day, cyclophosphamide 100 mg/day and prednisolone 10 mg/day were administered through in indwelling catheter inserted into the internal mammary artery and/or subclavian artery for 3-4 weeks, employing the implantable port system for the treatment of unresectable breast cancer and recurrent cancer. Ten out of 11 patients (91%) with unresectable breast cancer showed a response (CR 3, PR 7, NC 1) to this modality of intra-arterial infusion chemotherapy. Seven out of 11 patients (64%) with recurrent cancer of the breast showed a response (CR 1, PR 6, NC 4). Intraarterial infusion chemotherapy for the unresectable advanced breast cancer and recurrent breast cancer proved to be an effective modality of treatment.