[Usefulness of spiral CT in the detection of hypovascular, well-differentiated hepatocellular carcinoma]

Whole liver scanning during artery-dominant phase using spiral CT was performed in 14 patients with 17 histologically proven well-differentiated HCCs, which were not depicted by hepatic digital subtraction angiography but by CT during arterial portography. The density of HCC relative to the liver was evaluated with conventional precontrast CT, spiral CT, and following conventional CT during the equilibrium phase. Comparison between spiral CT and magnetic resonance (MR) imaging of dynamic contrast studies was also investigated. Four tumors of 17 HCCs (24%) were shown as a high-density area by the artery-dominant phase using spiral CT. Consequently, the total sensitivity of these three kinds of CT techniques was elevated to 82%. The sensitivity of dynamic MR imaging was slightly greater than that of spiral CT. However, spiral CT sometimes made the diagnosis more conspicuous by it's good spatial resolution. Our results indicate that spiral CT has a potential benefit in the detection of hypovascular well-differentiated HCC, and MR imaging and spiral CT may be complement each other.

A new method of intra-arterial regional chemotherapy with more selective drug delivery for locally advanced pancreatic cancer

BACKGROUND/AIMS

In order to deliver the anti-cancer drugs more selectively into the cancer tissues, we have developed a new method of intra-arterial regional chemotherapy for locally unresectable cancer of the exocrine pancreas.

MATERIALS AND METHODS

This method involved placing the catheters selectively into the splenic artery and/or into the gastroduodenal artery during laparotomy. Postoperatively, via the catheter, we infused 50-100 mg of Methotrexate mixed with 10 micrograms of Angiotensin-II with an intent of increasing the blood flow in the tumor tissue but decreasing that to the non-tumor tissues. Simultaneously, a bolus iv-infusion of 5-fluorouracil (5-Fu, 500 mg) was performed. One day after each chemotherapy, citrovorum factor (Leucovorin, 30mg) was given per orally, For 15 patients with locally non-resectable pancreatic cancer, this treatment was repeated weekly or biweekly at our out-patient clinic.

RESULTS

As a result, the toxicity was so slight that all patients could tolerate this treatment as long as the catheter was patent (11 +/- 8 postoperative months). The survival period was 16 +/- 9 months (range: 5-36 months; median: 14 months), and one-, two- and three- year survival rates were 60%, 23% and 11%, respectively. Patients could take care of themselves within 12 +/- 9 months, and either complete (50%) or partial (50%) pain-relief was obtained among the 12 patients with severe pain. Only one patient experienced local tumor regression during the chemotherapy, and the incidence of liver metastasis was as low as 13%.

CONCLUSIONS

Comparing with the previously reported data in the traditional chemo- and/or radio-therapies, we consider that our method of intra-arterial chemotherapy is quite useful not only for the prolongation of patient's survival but also for improving the quality of life. Thus, this new treatment seems worthy of entering into the prospective randomized study.

A nude mouse Wilms' tumor line (KCMC-WT-1) derived from an aniridia patient with monoalleleic partial deletion of chromosome 11p

BACKGROUND

A candidate tumor suppressor gene, WT-1, is believed to have an important role in the pathogenesis of Wilms' tumor, especially that occurring in patients with congenital aniridia.

METHODS

To obtain a stable tumor line to work with, Wilms' tumor tissue was serially transplanted in athymic nude mice. Biopsied Wilms' tumor tissue, derived from an aniridia patient, was transplanted subcutaneously to an athymic nude mouse, and then transplanted serially. Histopathologic and molecular biologic studies were performed on the xenotransplants.

RESULTS

The aniridia patient showed partial deletion in one short arm of chromosome 11, which bears the WT-1 gene. The tumor was successfully transplanted in the nude mouse. Although the tumor contained blastemic, organoid, and stromal histologic elements, the organoid element began to decrease after more than 20 passages. Cytogenetic analysis revealed an additional abbreviation of one long arm of chromosome 6. Dot blot analysis showed that the copy number of WT-1 gene was decreased to half the amount in the tumor, in spite of the WT-1 transcript with normal size detected by Northern blotting.

CONCLUSIONS

The tumor is expected to bear one WT-1 gene with minute abnormalities as well as one congenitally deleted gene. This tumor line is useful when examining the effect caused by introduction of WT-1 gene to Wilms' tumor in vivo.

[Late pericardial effusion after open-heart surgery: usefulness of pericardiocentesis under echocardiographic guidance]

Late pericardial effusion (PE) after open heart surgery has a potential for serious complications, including tamponade necessitating urgent drainage. From October 1990 to March 1995 moderate to massive PE developed following 9 of 359 (2.5%) cardiac procedures between 11 and 55 days postoperatively (mean, 18.6 days). Only one of these nine patients had evidence of cardiac tamponade; the other 8 patients had moderate symptoms including malaise, weight gain, and dyspnea on exertion. All patients except one were being treated with warfarin and anti-platelet agents. Echocardiography detected posterior PE of variable magnitude in all 9 patients; anterior PE was present in only one of these patients. Pericardiocentesis under echocardiographic guidance using an echo transducer with a built in puncture needle was performed in all patients. A flexible catheter was left in place for 24 to 72 hours for suction. In each case, 300 to 712 ml of old bloody fluid (mean, 475 ml) was evacuated, with relief of symptoms. Despite continuing anticoagulant therapy, there was no recurrence of pericardial effusion. The technique we have described simplifies pericardiocentesis and helps to avoid complications in this procedure.

Epidemiological study of Mycoplasma pneumoniae infections in japan based on PCR-restriction fragment length polymorphism of the P1 cytadhesin gene

Two hundred fifty strains of Mycoplasma pneumoniae isolated during the past 20 years in Japan were classified into two groups (I and II) based upon different PCR-restriction fragment length polymorphism patterns of their P1 cytadhesin genes. Clear shifts between the M. pneumoniae groups were observed but did not appear to be correlated with M. pneumoniae epidemic cycles. Patients' sera showed relatively higher levels of antiadhesin antibodies to M. pneumoniae strains homologous with the infecting strain.

Fusion of an ETS-family gene, EIAF, to EWS by t(17;22)(q12;q12) chromosome translocation in an undifferentiated sarcoma of infancy

EIAF is a newly isolated ETS-family gene that is located on 17q21 and codes for the adenovirus EIA enhancer-binding protein. In our chromosome analysis of 18 of the Ewing family of tumors and undifferentiated sarcomas, we found t(17;22)(q12;q12) in an MIC2 antigen-positive undifferentiated sarcoma of infancy. On Southern blot analysis, EWS and EIAF cDNA probes hybridized to the same rearranged band, indicating that an EWS-EIAF fusion gene was formed in the tumor. Further Southern blot analysis using four EIAF cDNA probes of different sizes showed that the breakpoint lies in the region upstream to the ETS domain of the EIAF gene. EIAF may be the fourth ETS-family gene to be identified forming a fusion gene with EWS. We assume that the RNA binding domain of EWS may have been replaced by the DNA binding domain of EIAF in the EWS-EIAF fusion protein as in other fusion proteins previously characterized in Ewing sarcoma and other types of sarcomas.

Echocardiography-guided pericardiocentesis with a needle attached to a probe

Pericardiocentesis with a needle attached to a probe was performed under two-dimensional echocardiographic guidance in 9 patients with pericardial effusion after cardiac operations. The first 5 mm of the tip of a puncture needle for percutaneous transhepatic cholangiodrainage is scratched with a scalpel to give the tip high echo intensity. When the probe is placed on the skin, the direction of puncture at that probe angle appears automatically on the monitor.

[The process and effect of heaviness exercise in autogenic training: factor analytical study of subjective response induced by the concentration upon and formal language of the sense of heaviness in the arm]

The present study examined the subjective response induced by the concentration upon and repetition of the formal language expressing the sense of heaviness--"The arm is heavy." As a result of the factor analysis of the experiment using 60 subjects, the following five factors emerged. (1) Overall sense of improvement; (2) awareness of the sensation of the arm; (3) change to less nervousness; (4) awareness of positive aspects; (5) understanding of the formal language. Also, those who were aware of psychosomatic symptoms felt their change to less nervousness more significantly, and their understanding of the formal language was significantly higher than those who were not aware of psychosomatic symptoms. The result of the experiment suggests one possibility that excessive concentration upon the body concerning psychosomatic symptoms may have changed to the concentration upon the sense of heaviness, or that the reduction of the stress thereof may have brought the change to less nervousness.

[Clinical value of carbohydrate antigens, sialyl Lewis-x and sialyl Lewis-a in gastrointestinal cancer]

To evaluate clinical importance of the expression of sialyl Lewis-X (sLe(x)) and sialyl Lewis-a antigen (sLe(a)) in gastrointestinal cancers, we examined immunohistochemically expression of the two antigens in esophageal, gastric, colorectal, and pancreatic cancer. Expression of sLe(x) and sLe(a) were associated with several clinicopathologic features which reflect tumor aggressiveness in esophageal, gastric and colorectal cancer, but not in pancreatic cancer. In esophageal and colorectal cancer, survival rate of the patients with sLe(x) positive tumors was significantly poorer than that of the patients with sLe(x) negative tumors, while in gastric cancer that with sLe(a) positive tumors was significantly poorer than that with sLe(a) negative. Cox's multivariate analysis revealed that sLe(x) expression status was one of the significant discriminants of prognosis in colorectal cancer patients and sLe(a) status in gastric cancer patients. These results suggest that sLe(x) and sLe(a) expression could be involved in aggressiveness of gastrointestinal cancer and might prove to be a potent marker for prognosis in patients with gastric cancer and colorectal cancer.

Residual bacterial infection in the tympanic cavity following surgery for ears with chronic discharge

In surgical treatment of ears with chronic discharge, pathogenic microorganisms may remain in the middle ear even after meticulous tympanomastoidectomy, and cause recurrent infection unless an appropriate antimicrobial agent is administered. The present study was conducted to determine the incidence of residual bacterial infection in the tympanic cavity by examining secretions from a drainage tube placed there via the mastoid cavity during surgery. Comparison of the bacterial flora before and after surgery demonstrated that some of the microorganisms continued to be present in the tympanic cavity for up to 2 weeks despite medication, and that the incidence of Pseudomonas aeruginosa and Staphylococcus epidermidis remained fairly high.

Hepatocellular carcinoma: comparative study among precontrast, artery-dominant, and delayed-contrast phase images at ultrafast CT

To evaluate the detectability of hepatocellular carcinoma (HCC) at artery-dominant phase and to compare it with that at precontrast and delayed-contrast phases, 34 patients with 109 HCCs were examined by ultrafast computed tomography (CT) using an incremental dynamic technique under single breath-holding. Images of three phases (precontrast, artery-dominant, and delayed) were compared with iodized-oil CT images. None of the lesions were detected only at precontrast phase. HCC detectability at the artery-dominant phase (87/109, 80%) was significantly superior to that at precontrast phase (32/109, 29%) (p < .01) and delayed-contrast phase (57/109, 52%) (p < .01). All 31 lesions missed at delayed-contrast phase were depicted at artery-dominant phase, while one lesion observed at delayed-contrast phase was missed at artery-dominant phase. Incremental dynamic CT at artery-dominant phase was suitable for the diagnosis of HCCs. Precontrast phase images were not necessary, although delayed-phase images were useful for the evaluation of tumor extension in some cases.

Treatments for second malignancies after gastrectomy for stomach cancer

BACKGROUND/AIMS

Metachronous primary cancers after stomach cancer were reported as a cause of late death. It is necessary to treat these second malignancies to improve the result of surgical treatment for gastric cancer.

MATERIAL AND METHODS

Among 3,570 patients who underwent gastrectomy during 1961-1986, 160 second primary malignancies were observed as of December of 1991. Liver (27 patients) and colorectal (18 patients) cancers were the largest in number.

RESULTS

By the end of 1992, for 32 liver tumors small resection, transcatheter arterial embolization and percutaneous ethanol injection were carried out and 3-year survival of resected cases (6 patients; 80.0%) was better than that of nonresected cases (26; 3.8%) (p < 0.05). In 19 colorectal cancers, surgical resection (13/19) and combined locoregional chemotherapy (2/19) were actively performed, and 5-year survival of resected cases (13; 55.4%) was better than that of nonresected cases (6; 0%) (p < 0.05).

CONCLUSION

With an intensive long-term follow-up after gastrectomy for cancer, early diagnosis and effective therapy for second primary malignancies is improved.

Purification and characterization of a novel serine proteinase from the microsomal fraction of bovine pancreas

A novel trypsin-like serine proteinase was purified to homogeneity from the bovine pancreas microsome fraction. The enzyme was solubilized with 3-[(3-cholamidopropyl)-dimethyl-ammonio]-1-propanesulfonate (CHAPS), and purified by a series of column chromatographic steps on Ultrogel AcA-34, trypsin inhibitor-Sepharose 4B, and arginine-Sepharose 4B. The molecular mass of this pancreas trypsin-like proteinase (bPTLP) was estimated to be 29.5 kDa by SDS-PAGE under reducing conditions. The NH2-terminal sequence of bPTLP is very homologous, but not identical to those of other serine proteinases, especially such as elastases IV, II, and III. Substrate specificity studies involving a synthetic substrate and glucagon indicated that the enzyme hydrolyzes Arg-X, Lys-X, and Leu-X bonds. The best synthetic substrate for bPTLP was t-butyloxycarbonyl Gln-Arg-Arg-4-methylcoumaryl 7-amide. The enzyme failed to hydrolyze the substrate for chymotrypsin and elastase. The enzyme activity was inhibited by diisopropyl fluorophosphate, p-amidinophenylmethane sulfonylfluoride, and leupeptin, indicating that it is a serine-proteinase. These findings show that bPTLP is a novel serine-proteinase which differs from all known proteinases. The physiological function of the enzyme has yet to be determined.

Gamma Knife radiosurgery for brain stem metastases: two autopsy cases

Early neuropathological findings were obtained at autopsy in two cases of brain stem metastasis treated with the Gamma Knife. In both cases, light microscopy radiation changes were strictly localized. Residual tumor tissue in the irradiation field showed marked degenerative changes including multinuclear cells, atypical nuclei and vacuolar degeneration. A characteristic finding in the irradiation field was fibrosis associated with hyalinized and thickened vessels. In more peripheral regions, demyelination and vacuolar degeneration were seen. This is the first report demonstrating extravascular fibrosis in the irradiated field following radiosurgery.

Expression of prohormone convertase, PC2, in adrenocorticotropin-producing thymic carcinoid with elevated plasma corticotropin-releasing hormone

An autopsy case of ACTH-producing thymic carcinoid with Cushing's syndrome is reported. The patient was a 63-yr-old man with multiple bone metastases from an undetermined primary site. Hyperpigmentation was observed at the terminal stage. The plasma levels of ACTH, cortisol, chromogranin A, and urinary 17-hydroxy-corticosteroids were extremely high, and ectopic ACTH-producing neuroendocrine tumor was diagnosed. In addition, plasma CRH was high. Autopsy revealed that the patient had primary thymic carcinoid with extensive metastases. Remarkable hyperplasia of the adrenal cortexes and Crooke's hyaline degeneration of the pituitary gland were consistent with Cushing's syndrome by ectopic ACTH production. There were multiple CRH-producing cells without degenerative changes in the hypothalamus. The tumor cells were immunoreactive to ACTH, CRH, and the cleavage enzyme PC2. POMC messenger ribonucleic acid and PC2 messenger ribonucleic acid were detected in the tumor cells by an in situ hybridization method. Expression of PC2 was considered to induce hyperpigmentation by producing alpha MSH. Despite hypercortisolism and ectopic production of CRH by the tumor cells, hypothalamic CRH cells were not atrophic. This case is a good example to demonstrate the correlation between CRH and the hypothalamo-pituitary-adrenal axis as well as hyperpigmentation in Cushing's syndrome.

Diagnostic imaging of idiopathic adult respiratory distress syndrome (ARDS)/diffuse alveolar damage (DAD) histopathological correlation with radiological imaging

In ten patients with idiopathic adult respiratory distress syndrome (ARDS) who had histopathologically diffuse alveolar damage (DAD), and who did not have specific underlying diseases, we compared the histopathological findings with their radiographic images in order to study the detail analysis of radiographic images and the clinical courses. These patients were roughly classified as having the interstitial pneumonia dominant type (type IP) of idiopathic ARDS, in which alveolar septal thickening, alveolitis, or both were the predominant histological findings and images showed increasing attenuation of lung fields with small honeycomb lung, or the organizing pneumonia dominant type (type OP), in which organizing exudate predominantly filled the alveoli histologically and images showed consolidation shadows with some air. Hyaline membrane was seen very frequently in patients with a short clinical course, and in accordance with a longer clinical course, widespread fibrosis and honeycomb lung covered by organizing hyaline membrane was seen with both types. Patients with type OP in whom collapse of the normal pulmonary structure was less and for whom changes on radiographic images were larger seemed to respond relatively favorably to steroid treatment, as judged from pulmonary function and radiographic images.

Selectivity of action of staurosporine on Ca2+ movements and contractions in vascular smooth muscles

We examined the effects of staurosporine, a protein kinase inhibitor, on Ca2+ movements and contractions due to KCl and 12-deoxyphorbol 13-isobutyrate (DPB), which are thought to activate myosin light chain kinase and protein kinase C, respectively. In rabbit aortae, staurosporine inhibited contractions due to KCl (65.4 mM) and DPB (1 mu M) with IC50 values of 140.5 +/- 1.3 nM and 13.3 +/- 1.3 nM, respectively. Calphostin C, a putative inhibitor of protein kinase C, inhibited DPB-induced contraction with much less effect on the KCl-induced one. On the other hand, wortmannin, an inhibitor of myosin light chain kinase, was 4 times more potent on KCl-induced contraction than the DPB-induced one. Staurosporine at 100 nM decreased the rise in cytosolic Ca2+ due to KCl, whereas wortmannin did not affect it. In rabbit cerebral arteries permeabilized with beta-escin, staurosporine at 100 nM, but not 30 nM, inhibited Ca2+ -induced contraction in the presence of 1 mM ATP. The results indicate that staurosporine preferentially inhibits a contraction dependent on protein kinase C than that dependent on myosin light chain kinase in vascular smooth muscles. Its ability to inhibit KCl-induced contraction involves inhibition of voltage-dependent Ca2+ channels.

Attenuation of memory with Tyr-D-Arg-Phe-beta-Ala-NH2, a novel dermorphin analog with high affinity for mu-opioid receptors

The involvement of mu-opioid receptors in memory retrieval was examined in mice by using Tyr-D-Arg-Phe-beta-Ala-NH2 (TAPA), a novel dermorphin analog with high affinity for mu-opioid receptors, and passive avoidance learning. TAPA was intracerebroventricularly administered to mice before retention tests of passive avoidance learning. A 0.3-ng dose of TAPA markedly shortened step-down latency of passive avoidance learning, and the shortening of step-down latency was reversed by treatment with beta-funaltrexamine (5 micrograms), a mu-opioid receptor antagonist, indicating that TAPA (0.3 ng) attenuates memory retrieval. Although the attenuating dose (0.3 ng) of TAPA failed to affect horizontal or vertical locomotor activity, a 3-ng dose of TAPA showed a tendency to decrease vertical locomotor activity. A 30-ng dose of TAPA produced a significant increase in horizontal locomotor activity accompanied by a marked reduction of vertical locomotor activity. TAPA (3 ng) produced a significant increase in step-down latency of passive avoidance learning with lower intensity of electroshock or without electroshock during training. These results suggest that the activation of mu-opioid receptors impairs memory retrieval.

[Primary pulmonary malignant lymphoma of the T-cell type]

A 65-year-old woman was referred to our department because of an abnormal shadow on the chest roentgenogram. The chest roentgenogram showed infiltrative shadows in the right middle and lower lung fields. The chest CT scan showed non-segmental infiltration with a hazy margin and a clear air bronchogram in the right S8 area. A transbronchial aspiration cytology specimen showed atypical lymphocytes, and a transbrochial lung biopsy specimen showed infiltration by atypical lymphocytes. Malignant lymphoma was suspected from the results of the biopsy examination, and a right middle and lower lobectomy was done. The pathological findings showed proliferative atypical lymphocytes in the alveolar and interstitial areas. Malignant lymphoma (diffuse medium cell type by LSG classification) was diagnosed and an immunohistiochemical examination showed monoclonal proliferation of T lymphocytes, which were positive for T lymphocyte surface marker (UCHL-1). Therefore, we believe this was a case of primary pulmonary malignant lymphoma of the T-cell type.

Protective effect of thromboxane synthetase inhibitor on hypertensive renal damage in Dahl salt-sensitive rats

1. The effects of OKY-046, a specific thromboxane (TX) synthetase inhibitor, on blood pressure, urinary excretion of TX and its release from blood platelets and renal papilla, and pathological change of glomeruli were evaluated in Dahl salt-sensitive rats. 2. Average daily intakes of OKY-046-treated rats were 0.93 mg/kg (low dose), 9.8 mg/kg (moderate dose), and 88 mg/kg (high dose). 3. Systolic blood pressure tended to decrease by 6.3, 11.4, and 10.9% in three OKY-treated groups. 4. OKY-046 suppressed the release of TX from platelets in a dose-dependent fashion. Both TX in urine and released from renal papilla decreased in OKY-treated groups with moderate and high dose. OKY-046 resulted no change in urinary excretion or release from renal papilla of prostaglandin E2 or 6-keto-prostaglandin F1alpha. 5. Glomerular sclerosis score decreased significantly in both groups treated with moderate and high doses of OKY-046. 6. An inhibition of renal TX synthesis by TX synthetase inhibitor has a protective effect on the development of hypertensive renal damage with minor antihypertensive effect in Dahl salt-sensitive rats.

[Verification of rotational conformation radiotherapy using megavoltage CT scanning]

Although portal imaging is a promising method of verification during static multi-port irradiation, it cannot be applied directly to dynamic irradiation such as rotational conformation with multi-leaf collimator movement. A real-time beam monitoring system based on megavoltage computed tomography scanning has been developed to establish a verification method for the rotational conformation technique. The exit beam through the patient is extracted by the same detector unit as that used for megavoltage scanning during the actual treatment. The beam edge is defined as the 50% level of the maximum dose of the detector array. Megavoltage computed tomography is done after patient setup and just prior to the actual irradiation. Detected beam pathways are overlaid on this image approximately every 1 sec. Therapists can monitor the correlation between the target and actual beam pathways on a real-time computer display. The accuracy of field edge detection has been proven to be less than 2 mm from various measurements. Field errors were identified in two of 54 sessions using this method. Although several limitations remain to be solved, the method presented is an useful tool for treatment verification of high accuracy radiation therapy, particularly rotational conformation irradiation.