Phase I study of paclitaxel by three-hour infusion: hypotension just after infusion is one of the major dose-limiting toxicities

The primary objectives of this study were to determine the maximum tolerated dose (MTD) of paclitaxel administered by 3-h infusion to patients with solid tumors, and to characterize the pharmacokinetics of a 3-h infusion in comparison with those of a 24-h infusion. Twenty-seven patients each received one of six levels of paclitaxel, 105, 135, 180, 210, 240 and 270 mg/m2, with premedication. Two patients given 240 mg/m2 and one patient given 270 mg/m2 unexpectedly had grade 3/4 hypotension just after finishing the paclitaxel infusion. Peripheral neuropathy was also dose-limiting at 270 mg/m2. Although granulocytopenia was significantly less severe than with a 24-h infusion, more than half of the patients experienced grade 4 toxicity at doses of 240 or 270 mg/m2. Severe hypersensitivity reactions (HSRs) were not observed. Pharmacokinetic studies using high performance liquid chromatography demonstrated proportionally greater increases in the peak plasma concentration and area under the curve, and decreases in clearance and volume of distribution with increasing dose, suggesting non-linear pharmacokinetics of paclitaxel when given by 3-h infusion. The MTD of paclitaxel given as a 3-h infusion was determined to be 240 mg/m2 with dose-limiting toxicities of granulocytopenia, peripheral neuropathy and hypotension. Hypotension just after infusion, induced by 3-h infusion of paclitaxel, is a new observation which has not been reported previously. The recommended dose for phase II study is 210 mg/m2. Although hypotension was observed as an unexpected toxic effect, paclitaxel could be administered safely over 3 h with premedication and proper monitoring, resulting in reduced myelotoxicity and with no increase in the incidence of HSRs as compared with a 24-h infusion.

A new method for the assay of exposed platelet fibrinogen receptor using a chemiluminescent label

Assay of the platelet fibrinogen-binding receptor glycoprotein (GP) IIb/IIIa is widely performed using 125I-labeled fibrinogen (125I-fibrinogen). We successfully devised a receptor binding assay system with high selectivity and sensitivity using a stable chemiluminescent acridinium derivative-I-labeled fibrinogen (acridinium-fibrinogen). Human fibrinogen is saline was labeled with equimolar acridinium dissolved in dimethylformamide, and allowed to react with gel-filtered human platelets in the presence of ADP. Acridinium-fibrinogen binding to GPIIb/IIIa was assayed by measuring chemiluminescence emitted on addition of 0.1 N NaOH containing 0.06% H2O2 in a luminometer. Non-specific binding was measured in the presence of 10 mM EDTA. Acridinium-fibrinogen binding to human platelets was rapid and reversible, specific and saturable, and dependent on ADP concentrations. Scatchard plot analysis revealed one class of binding sites with Kd of 326 nM and Bmax of 7.8 pmol/10(8) platelets. These values were comparable to the data obtained by using 125I-fibrinogen. Unlabeled fibrinogen, RGDS, and HHLGGAKQAGDV (fibrinogen gamma-chain 400-411) displaced acridinium-fibrinogen from its binding site with Ki values of 322 nM, 9.2 microM and 31.3 microM, respectively. Thus, this binding assay system may be useful in measuring the binding between platelet GPIIb/IIIa and fibrinogen without using a radioisotope.

Gene expression of prostacyclin receptor in the hypertrophied heart of spontaneously hypertensive rats

1. Prostacyclin elicits potent vasodilation and inhibition of platelet aggregation through binding to its membrane receptor. The impairment of prostacyclin receptor activity is implicated in various human cardiovascular diseases. We recently succeeded in molecular cloning of cDNA for the mouse, rat, and human prostacyclin receptors. 2. In the present study, we examined the mRNA expression of the prostacyclin receptor in various rat tissues, and further investigated its gene expression in the hypertrophied cardiac ventricles of stroke-prone spontaneously hypertensive rats (SHRSP). 3. In rat tissues, a single RNA band of approximately 3.7 kb was detected by northern blotting analysis using rat prostacyclin receptor cDNA as a probe. In adult Wistar rats, abundant mRNA expression was observed in the aorta, lung and spleen. Substantial amounts of transcript were expressed in the heart, pancreas, thymus and stomach. In contrast, no mRNA expression was detected in the brain. 4. We further examined the mRNA expression of the prostacyclin receptor in the ventricles of 21 week old SHRSP. The ventricles of SHRSP showed remarkable hypertrophy, compared with those of age-matched Wistar-Kyoto (WKY) rats. The expression of prostacyclin receptor mRNA in the hypertrophied ventricles of SHRSP was almost equivalent to that in the ventricles of WKY. 5. The present study revealed the gene expression of the prostacyclin receptor in various rat tissues, and further demonstrated the receptor mRNA expression in hypertensive cardiac hypertrophy. The present study will give a clue to investigate the clinical implication of prostacyclin and its receptor.

The confusion associated with breast cancer chemotherapy in Japan: the first year's experience at the Division of Oncology and Hematology, National Cancer Center Hospital East

The current status of breast cancer chemotherapy in Japan was examined and compared with internationally accepted standard therapy, by reviewing the previous treatment of patients with advanced or metastatic breast cancer who had been referred to the National Cancer Center Hospital East. Forty patients were referred mainly from middle-sized or large hospitals between July 1992 and June 1993. The most commonly used regimen for adjuvant therapy was a combination of long-term and oral low-dose fluoropyrimidine compounds (LDFU), which is rarely used in Western countries, and tamoxifen. Some patients had received perioperative intravenous mitomycin C. The adjuvant polychemotherapy most commonly used internationally has been given to only a few patients. The first-line treatment for advanced or metastatic disease in the previous hospitals varied, but myelosuppressive chemotherapy including anthracyclines was given to half of the patients. Oral LDFU was also used for some patients alone or in combination as the first-line chemotherapy. Local therapy for metastasis to soft tissue was performed in 9 patients. Oral LDFU therapy that is frequently used for cancer treatment in Japan should be evaluated in a well designed controlled trial.

A canine case of discoid lupus erythematosus with circulating autoantibody

A nine-year-old Shetland sheepdog was diagnosed as discoid lupus erythematosus by clinical features, histopathologic findings, positive direct immunofluorescence, negative antinuclear antigen test and the absence of multisystemic diseases. The indirect immunofluorescence test of this patient dog with the salt split skin showed the deposition at the bottom of the cleft at basement membrane zone (BMZ). Western immunoblotting revealed the 120 kDa and the 85 kDa proteins targeted by the autoantibody. These proteins did not correspond with the known BMZ component.

Clinical significance of decreased myocardial uptake of 123I-BMIPP in patients with stable effort angina pectoris

The aim of this study was to assess the feasibility of resting myocardial fatty acid metabolic imaging with 123I-beta-methyliodophenyl-pentadecanoic acid (123I-BMIPP) for the detection of patients with stable effort angina pectoris and to clarify the clinical significance of abnormal 123I-BMIPP images. Myocardial imaging with 123I-BMIPP at rest and 99Tcm-methoxyisobutyl isonitrile (99Tcm-MIBI) at rest and during treadmill exercise was performed in 46 patients with suspected effort angina pectoris. Resting 123I-BMIPP imaging detected 43% (17/40) of patients with significant (> or = 50%) coronary artery stenosis and 59% (17/29) of patients with exercise-induced myocardial ischaemia. The patients with abnormal 123I-BMIPP images terminated exercise after a shorter period (4.5 +/- 2.6 vs 6.7 +/- 4.1 min; P < 0.01) and at a lower rate pressure product (16,124 +/- 5211 vs 20,246 +/- 6564 mmHg x beats min-1; P < 0.01) than those with normal 123I-BMIPP images. The presence of ST depression during the exercise test (77 vs 52%; P < 0.05), severe coronary stenosis exceeding 90% (88 vs 43%; P < 0.01), collateral vessels (35 vs 9%; P < 0.01) and a wall motion abnormality of hypokinesis/akinesis (53 vs 30%; P < 0.05) were more frequently seen in patients with abnormal 123I-BMIPP images than in those with normal images. Resting 123I-BMIPP imaging was able to detect the presence of coronary artery stenosis and exercise-induced myocardial ischaemia with moderate sensitivity, and to determine the functional severity of coronary artery disease.

Subcellular fractions of cyclic AMP and cyclic AMP-dependent protein kinase and the positive inotropic effects of selective beta 1- and beta 2-adrenoceptor agonists in guinea pig hearts

We studied the effects of a full beta 1-adrenoceptor agonist (T-0509), a beta 2-adrenoceptor agonist (procaterol) and a nonselective beta-adrenoceptor agonist (isoproterenol, ISO) on subcellular cyclic AMP levels and cyclic AMP-dependent protein kinase (cyclic AMP-PK) activity in guinea pig hearts and compared them with the effect of each drug on cardiac contractility. T-0509 (10(-8)M) and ISO (3 x 10(-8)M) caused an increase of approximately 170% in dF/dtmax, whereas 10(-7) procaterol produced only a 25% increase. All these agonists significantly increased the cyclic AMP level in ventricular homogenate. Subcellular fractions were obtained by centrifugation at 100,000 g for 10 min and by Li2SO4 precipitation of the 100,000-g supernatant. In the control heart, probably salcolemmal protein, phospholamban, and 60-kDa protein in the particulate fraction and probably troponin I and troponin C in the supernatant fraction were mainly phosphorylated by the catalytic subunit of cyclic AMP-PK. In the precipitate obtained from the supernatant fraction with Li2SO4, probably all proteins described were contained. However, none of the proteins were detected in the supernatant obtained with Li2SO4. T-0509 and ISO caused significant changes in cyclic AMP levels and cyclic-PK activities in all fractions. However, procaterol increased the cyclic AMP concentrations and cyclic AMP-PK activities only in the supernatant fraction and the supernatant obtained with Li2SO4. T-0509 and ISO increased cyclic AMP level (9-16 pmol/mg protein) and cyclic AMP-PK activity ratio (0.27-0.33) significantly to the same degree in the precipitate obtained with Li2SO4, whereas the effects of T-0509 in other fractions were about twofold less than those of ISO. These results suggest that beta 1- and beta 2-adrenoceptor agonists cause differential compartmentalization of cyclic AMP and cyclic AMP-PK in the cardiac muscle.

Simultaneous determination of a new anticancer agent (NB-506) and its active metabolite in human plasma and urine by high-performance liquid chromatography with ultraviolet detection

A high-performance liquid chromatographic method with ultraviolet detection has been developed to quantify NB-506 and its active metabolite in human plasma and urine. This method is based on solid-phase extraction, thereby allowing the simultaneous measurement of the drug and metabolite with the limit of quantification of 0.01 microgram/ml in plasma and 0.1 microgram/ml in urine. Standard curves for the compounds were linear in the concentration ranges investigated. The range for the drug in plasma was 0.01-2.5 micrograms/ml, and for the metabolite 0.01-1 microgram/ml. In urine, the range for both compounds was 0.1-10 micrograms/ml. The method was validated and applied to the assay of plasma and urinary samples from phase I studies.

Evaluation of repeated balloon inflation in angioplasty as a clinical model of ischemic preconditioning

Reevaluation of repeated balloon angioplasty as a model of ischemic preconditioning and of the role of collateral circulation and high-frequency electrocardiograms in repeated inflations was carried out. There have been few studies using angioplasty as a model of ischemic preconditioning of the collateral circulation during repeated inflations or of the use of high-frequency electrocardiograms during angioplasty. Twenty patients underwent 3 repeated balloon inflations, each with a duration of more than 138 seconds. During inflation, ipsilateral and contralateral coronary angiography and signal-averaged electrocardiography were performed. At the 1st inflation, the ST segment gradually increased as the inflation time elapsed. During the 2nd and 3rd inflations, in which ST elevation was nearly equal, the ST segment gradually increased, but it was not as prominent as that at the 1st inflation; thus, the concept that ischemia is gradually ameliorated (adaptation to ischemia) was not documented. Comparison of the maximal ST elevation and ipsilateral and contralateral circulation at each inflation revealed that the ST segment became elevated and the contralateral collateral circulation increased significantly at the 1st inflation compared with those in the control. ST elevation, however decreased significantly and collateral circulation remained unchanged at the 2nd inflation; thus, collateral circulation did not cause the ST elevation decrease. The total root mean square voltage detected by signal averaging decreased significantly only at the 1st inflation. Balloon angioplasty is not always suitable as a model of ischemic preconditioning and collateral circulation is not the cause of ischemic preconditioning.

Dental health indicator based on a questionnaire

Dentistry has lacked an effective indicator of the impact of dental problems on a person's daily life. Subjective factors in dental health need to be included in order to improve current indicators. The purpose of this research was to develop a new type of indicator recorded from a questionnaire which takes account of subjective factors in dental health. The indicator we constructed has the following advantages. 1. Calculation process is simple in practice. 2. The indicator values range from 0 to 100, with values closer to 100 indicating a more favorable condition for the individual. 3. The distribution of indicator values is similar to the normal distribution. 4. The score of each item is reflected on the indicator, suggesting the individual's characteristics in terms of dental health. 5. Although it is principally an indicator for individuals, it can also be applied to groups. This study will also provide a model for the preparation of a dental health indicator.

Identification of virulence-associated antigens and plasmids in Rhodococcus equi from patients with AIDS

Rhodococcus equi is an emerging opportunistic pathogen of human immunodeficiency virus-infected patients. However, little is known about the characteristics of R. equi isolates from humans. This study characterized the plasmid content, expression of a virulence-associated antigen, and mouse virulence of 19 R. equi isolates from patients with and without AIDS. EcoRI digestion patterns and Southern, Western, and virulence analyses of these isolates with cryptic plasmids allowed definition of a new category of R. equi. Isolates from patients with AIDS tended either to be virulent and have 15- to 17-kDa antigens and an 85-kb plasmid (10(6) bacteria needed for lethality) or have intermediate virulence (10(7) bacteria needed for lethality) and one of four distinct large plasmids that share DNA homology and express a 20-kDa antigen. Most of the non-AIDS isolates were avirulent (> 10(8) bacteria needed for lethality) and did not express any of these antigens.

Does portal hypertension modify colonic mucosal vasculature? Quantification of alteration by image processing and topology

OBJECTIVE

Endoscopic images of the colonic mucosal venous structure in eight cirrhotic patients with esophageal varices and in eight noncirrhotic subjects were analyzed to qualitatively determine whether or not the vasculature be altered by persisting portal hypertension.

METHODS

On the endoscopic images, a venous network consisting of confluent venous branches draining into one penetrating vein was as a whole defined as one "venous unit." For each venous unit, the area of vein bed was calculated by means of an image processor. Each venous network was idealized to be a graphic representation consisting of lines (venous routes) and dots (origins, terminations, branching or anastomosing), on which two topological variables, the total number of zero-dimensional cells (a0) and the Betti number of dimension-1 (beta 1[K]), signifying the complexity and the number of venous anastomoses, respectively, were determined.

RESULTS

The area of vein bed (mean +/- SD) was significantly greater (p < 0.01) for the cirrhotic patients (41 +/- 37 mm2) than for the noncirrhotic subjects (24 +/- 12 mm2). The a0 was also greater (p < 0.01) for the patients (68 +/- 29) than for the noncirrhotic subjects (42 +/- 17). The beta 1[K] for the patients was significantly greater (p < 0.01) for the cirrhotic subjects (7.1 +/- 4.4) than for the noncirrhotic subjects (2.6 +/- 2.9).

CONCLUSION

The image processing and topological analysis of the colonic mucosal veins demonstrated that persistent portal hypertension alters the colonic mucosal venous structure by increasing the caliber of the veins and the number of merges (branching or anastomosing) between them.

[Effect of KW-4679, a novel antiallergic drug, on platelet-activating factor (PAF)-induced bronchoconstriction, airway hyperresponsiveness and pulmonary cell accumulation in guinea pigs]

We assessed the effects of KW-4679 on bronchoconstriction, airway hyperresponsiveness and infiltration of inflammatory cells into the bronchoalveolar lavage (BAL) fluid induced by platelet-activating factor (PAF) in guinea pigs. (1) KW-4679 (1, 10 mg/kg, p.o.) significantly inhibited PAF-induced bronchoconstriction in anesthetized, ventilated guinea pigs. Ketotifen (1, 10 mg/kg, p.o.) also significantly inhibited that reaction. (2) Intravenous administration of PAF (600 ng/kg/hr) to ventilated anesthetized guinea pigs induced bronchial hyperresponsiveness to histamine or substance P. PAF-induced bronchial hyperresponsiveness was significantly attenuated by pretreatment with KW-4679 (3 mg/kg, i.v.). (3) Exposure of guinea pigs to an aerosol of PAF induced an increase in the numbers of total leukocytes, eosinophils, neutrophils and lymphocytes in BAL fluid at 24 hr. KW-4679 (10 mg/kg, p.o.) reduced the increase in eosinophils in BAL fluid. Ketotifen (10 mg/kg, p.o.) partially reduced the increase in eosinophils in BAL fluid. (4) KW-4679 did not inhibit PAF-induced rabbit platelet aggregation. These observations indicate that KW-4679 attenuates the PAF-induced pulmonary reactions in guinea pigs and that these actions may be beneficial for the treatment of allergic bronchial asthma.

A surgically-treated case of left atrial myxoma complicating coronary artery fistula

A surgically-treated case of left atrial myxoma complicating congenital coronary fistula is reported. A review of the literature indicates that this complication has not been reported previously.

In vitro influence of Mycoplasma penetrans on activation of peripheral T lymphocytes from healthy donors or human immunodeficiency virus-infected individuals

Mycoplasma penetrans is a mycoplasma species newly isolated from the urine of human immunodeficiency virus (HIV)-infected individuals and presents the only case in which an association has been found between antibodies against a mycoplasma and HIV infection. To further explore the effects of M. penetrans on the immune system, we studied the influence of this mycoplasma on peripheral blood mononuclear cells (PBMCs) from healthy donors and HIV-infected individuals. M. penetrans induced, in addition to blastogenesis of PBMCs, a significant proliferative response associated with the expression of some activation markers such as CD69, HLA-DR, and CD25. This M. penetrans-dependent lymphocyte activation was observed not only in healthy donors but also in HIV-infected persons at different stages of the disease. In addition, our study revealed that both CD4+ and CD8+ T lymphocytes were responsive to M. penetrans. Interestingly, the mitogenic activity of M. penetrans was associated with mycoplasma cells but not with the supernatants of mycoplasma culture. The potent stimulating activity of M. penetrans on T lymphocytes from HIV-infected individuals is of particular interest in view of the supposed contribution of immune activation to HIV replication and disease progression.

Protein kinase C involvement in homologous desensitization of delta-opioid receptor coupled to Gi1-phospholipase C activation in Xenopus oocytes

We have developed the coexpression system of both delta-opioid receptor (DOR1) and M2-muscarinic receptor (M2) which mediate agonist-evoked currents due to common post-receptor mechanisms including Gi1 and phospholipase C (PLC) activation in Xenopus oocytes reconstituted with Gi1 alpha. The DOR1-currents by 100 nM D-Ser2-leu-enkephalin-Thr6 (DSLET) were selectively desensitized by 10 nM phorbol 12-myristate 13-acetate (PMA). The PMA-desensitization of DSLET-currents was abolished in the presence of calphostin C, a protein kinase C inhibitor, or reversed by an intracellular injection of calcineurin, a protein phosphatase 2B. When a higher concentration (3 microM) of DSLET was used, DSLET-currents were rapidly desensitized by repeated challenges of DSLET itself. However, repeated challenges of 10 microM ACh caused no influence on such DSLET- or M2-currents. The desensitization of DSLET-currents was selectively reversed by protein kinase C inhibitors. Similar results were also obtained with various delta-opioid agonists. These results suggest that protein kinase C is involved in the homologous desensitization of delta-opioid receptors.

[Pharmacological studies on KW-4679, an antiallergic drug. (1): Inhibitory effect on passive cutaneous anaphylaxis (PCA) and experimental asthma in rats and guinea pigs]

The present experiment was carried out to elucidate the antiallergic properties of KW-4679. Oral administration of KW-4679 showed a dose-dependent inhibition on the IgE-mediated 48-hr homologous PCA in rats, with an ID50 value of 0.04 mg/kg. Passive anaphylactic broncho-constriction in guinea pigs mediated by IgE-like homologous antibody against ovalbumin was prevented dose-dependently by treatment with KW-4679 at doses of 0.03-1 mg/kg, p.o. KW-4679 also inhibited the IgE-mediated active anaphylactic bronchoconstriction in rats. In passively sensitized guinea pigs, the inhalation of aerosol antigen decreased the dynamic compliance of the lung and increased the mean pulmonary resistance. Pretreatment with KW-4679 (0.03-1 mg/kg, p.o.) inhibited antigen-induced airway obstructions. Oral administration of KW-4679 significantly protected rats from compound 48/80-induced lethality. These results indicate that KW-4679 might be useful in the treatment of allergic diseases such as asthma.

Noninvasive recording of His bundle activity with an analog delay device in normal subjects and patients with atrioventricular block

A simplified and clinically applicable method has been developed for real-time noninvasive recording of the electrical activity of the His bundle in the human heart. A surface electrocardiogram (ECG) was obtained from bipolar precordial leads. The electrical signal within the P-QRS segment of the ECG was amplified with a high gain amplifier and delayed with an analog delay device for QRS-triggered signal averaging. The analog delay device consisted of a bucket brigade device (BBD) with an electrical integrated circuit (IC). After filtering with a band width of 50-300 Hz, the delayed signal was processed by a microcomputer system and the signal-to-noise ratio of the signal was improved by the signal averaging technique. Surface His bundle electrocardiograms (SHE) were measured in normal subjects without conduction disorders and in patients with atrio-ventricular (A-V) block. In the same patients, each SHE was nonsimultaneously compared with an invasive His bundle electrogram (HBE) obtained by the intracardiac catheter technique. The results of this comparison confirmed that the noninvasive method of SHE recording has broad clinical applicability and high utility for the screening of patients with latent A-V block before intracardiac catheterization is performed.

[Surgical repair of ventricular septal perforation following acute myocardial infarction in an 86-year-old man]

We reported on an 86-year-old man who underwent successful repair of ventricular septal perforation (VSP). He was admitted to our hospital with acute inferior myocardial infarction (MI). Color Doppler echocardiogram showed the VSP located in posterior ventricular septum and right heart catheterization revealed a Qp/Qs of 2.1. His hemodynamic condition worsened, necessitating initiation of intraaortic balloon pumping 11 days after the onset of MI. Surgical repair of the VSP was performed on that day. A posterior ventricular septal defect was repaired using the method advocated by Daggett: the ventricular septal defect was closed with a Teflon felt patch, and left ventricular free wall was closed with an artificial graft. The postoperative course was uneventful, and the patient is doing well at one year after operation. He was, to the best of our knowledge, the eldest patient to undergo successful operation for VSP in Japan.

Novel deltorphin heptapeptide analogs with potent delta agonist, delta antagonist, or mixed mu antagonist/delta agonist properties

A series of deltorphin (DLT: Tyr-D-Met-Phe-His-Leu-Met-Asp-NH2) analogs in which Leu5 and/or Met6 were mainly replaced by t-Leu(Tle) and/or N alpha-alkylated glycine were synthesized and examined for their receptor binding properties and in vitro bioactivities by guinea pig ileum (GPI) and mouse vas deferens (MVD) assays. [Tle5]DLT(2) showed a dramatic decrease in the MVD potency when compared to the parent peptide and was found to have a potent delta receptor antagonist activity against various delta agonists with Ke values of 16-311 nM. Interestingly, the antagonist potency of 2 against DPDPE as agonist was 20-fold weaker than that against deltorphins or Leu-enkephalin. Among the analogs in which Met6 was replaced by an N alpha-alkylated Gly residue, [N alpha-isobutyl-Gly6]DLT(5) behaved as a mixed mu antagonist/delta agonist while its isomeric analogs in which the N alpha-alkyl is n-butyl (4) or (R or S) sec-butyl (6a,b) were very potent delta receptor agonists. Analogs 2, 4, 6a, and 6b were highly stable against rat brain and rat plasma enzymes and thus may represent a starting point for the development of novel receptor-specific compounds useful as ligands for studies of opioid receptors.

The voltage-dependent K+ channel (Kv1.5) cloned from rabbit heart and facilitation of inactivation of the delayed rectifier current by the rat beta subunit

We have isolated a cDNA coding for a delayed rectifier K+ channel (RBKV1.5) from rabbit heart. The amino acid sequence of RBKV1.5 displays a homology to that of other K+ channels of Kv1.5 class. Overall amino acid identity between RBKV1.5 channel and Kv1.5 channel of other species is about 85%. RNA blot analysis revealed the expression of the primary transcript in various rabbit tissues, at the highest level in both the atrium and ventricle. When expressed in Xenopus oocytes, RBKV1.5 current showed a delayed rectifier type characteristics, which was converted to rapidly inactivating currents upon coexpression with a beta subunit.

[A case of hemolytic uremic syndrome associated with circulating anticoagulant]

A previously well 66-year-old woman was admitted to our hospital because of severe abdominal pain, oliguria, jaundice and hemoglobinuria. At admission, the following values were obtained: red blood cell count 261 x 10(4)/mm3, serum creatinine 2.8mg/100ml, total bilirubin 8.0mg/ml, indirect bilirubin 5.7mg/100ml, LDH 13886 WU, negative direct and indirect Coomb's test and peripheral blood smear showing schistocytosis. She was diagnosed as hemolytic uremic syndrome and was successfully treated with plasma infusion, plasma exchange and hemodialysis. The results of the tests for verotoxin titer of E. coli O157: H7 and circulating anticoagulant were positive. The test result for anticoagulant eventually became negative during her clinical course. In this case, circulating anticoagulant might have contributed to the pathogenesis of hemolytic uremic syndrome.

[Preoperative neoadjuvant chemotherapy with a combination of 5-fluorouracil, adriamycin and cisplatin (FAP) for advanced esophageal cancer invading trachea or main bronchus]

Conventional irradiation and systemic chemotherapy is scarcely effective for advanced esophageal cancer invading trachea or main bronchus. Therefore, to reduce the area of invasion and suppress distant metastasis, we have preoperatively treated 4 patients suffering from advanced esophageal cancer invading the trachea or main bronchus by neoadjuvant chemotherapy (FAP) as follows: 2 times every 4 weeks, CDDP 100 mg and ADR 50 mg on day 1 and continuous infusion of 5-FU 1,000 mg/day for 7 days. The response rate (PR) was 75% (3/4). In 2 of 4 patients (50%), no cancer cells except broad fibrosis were detected histologically in the region of the trachea or main bronchus suspected to be invaded. There was no severe complication. This FAP regimen is suspected to be useful chemotherapy for advanced esophageal cancer.