A cross-validation of the European Organization for Research and Treatment of Cancer QLQ-C30 (EORTC QLQ-C30) for Japanese with lung cancer

The EORTC QLQ-C30 was developed in English-speaking cultures. To determine if this instrument could cross a broad cultural divide and be used in Japan, the cross-cultural validity of its Japanese version was estimated. In evaluating psychometric testing, internal consistency by Cronbach's alpha, item-discrimination by multitrait scaling analysis, and validity analysis with ECOG performance score (PS) and Karnofsky Performance Status Scale (KPS) were performed. The QLQ-C30 (version 1.0) was given to 105 patients with lung cancer. Although the response rate was low in patients with PS 4, the questionnaire was well accepted by patients with PS 0-3. The Japanese QLQ-C30 has a weak scale of role functioning in terms of item discriminative validity. It also has a weak scale of cognitive functioning in items of discriminative validity and internal consistency. However, known-groups comparison showed the expected clinical validity with PS for all the scales except for financial impact, and longitudinally clinical validity with KPS was shown in scales of cognitive functioning, fatigue, and nausea and vomiting. Multitrait scaling analysis showed that the predicted scales constituting quality of life (QOL) in the English-speaking culture were extracted from the Japanese QLQ-C30, and found to be valid in Japan, indicating its possible usefulness as an instrument that is universally applicable across cultures.

Effects of anti-IL-5 monoclonal antibody on the murine model of nasal allergy

IL-5 is known to be closely related to the infiltration, activation and proliferation of eosinophils. In this study, we evaluated the in vivo effects of anti-IL-5 monoclonal antibody (mAb) in the murine model of nasal allergy. The mAb treatment inhibited the antigen-induced late phase eosinophilia, but had no effects on the number of basophilic cells. It also inhibited early phase nasal symptoms, and tended to inhibit histamine hypersensitivity. These findings suggest that IL-5 plays an important role in the pathogenesis of allergic nasal disorders.

Hepatocyte growth factor stimulates DNA synthesis in rat preneoplastic hepatocytes but not in liver carcinoma cells

BACKGROUND & AIMS

It is not well clarified whether hepatocyte growth factor (HGF) stimulates the growth of preneoplastic hepatocytes and liver carcinoma cells in vivo. The effect of HGF on in vivo DNA synthesis in these cells and also its effect on tyrosine phosphorylation of the HGF receptor protein (c-Met) in liver carcinoma were examined.

METHODS

Lesions were induced in rats using 3'-methyl-4-dimethylaminoazobenzene (3'-Me-DAB). The rats were given intravenous recombinant human HGF or vehicle, and DNA synthesis was assessed by the 5-bromo-2'-deoxyuridine labeling index. Tyrosine phosphorylation of c-Met by HGF was analyzed by Western blot.

RESULTS

The labeling indices were significantly higher in the HGF group than in the vehicle control group in altered foci and hyperplastic nodules (preneoplastic hepatic lesions). No significant differences in the labeling indices were observed between the two groups with carcinoma. Tyrosine phosphorylation of c-Met in carcinoma cells was unaffected by HGF administration.

CONCLUSIONS

HGF promotes the growth of preneoplastic hepatocytes but does not affect the growth of liver carcinoma cells in 3'-Me-DAB-treated rats.

Effect of extremely low dose cyclosporine treatment on the thrombocytopenia in systemic lupus erythematosus

Cyclosporine is widely known to be effective in cases involving both transplantation as well as a spectrum of immune-mediated diseases, although careful monitoring is required for the preemptive detection of its adverse effects. Here we report the successful treatment by extremely low dose cyclosporine (1 mg/kg per day) of two patients with thrombocytopenia in systemic lupus erythematosus.

[Obstructive sleep apnea in children with cerebral palsy]

To determine the etiology of obstructive sleep apnea (OSA) in children with cerebral palsy (CP), a survey using a questionnaire was conducted on parents of 233 CP children (1-5 years old, mean age: 2.7) and on those of 343 control children during a routine medical check-up at the age of three. The prevalence of habitual snoring and nasal obstruction was 63 and 20% in CP children, which were significantly higher than in control children. Sleep apnea episodes and stridor were noted in 19.7 and 15.4% of CP children. A screening sleep study was performed using Apnomonitor II and a pulseoximeter (Pulsox 5) in 48 CP children whose questionnaires revealed habitual snoring and sleep apnea, and it was found that 27 and 58% of the children had on apnea-hypopnea index (AHI) of greater than 5 and a low level of SaO2 (LSaO2) of less than 85%, respectively. When another 10 CP children visited our hospital for treatment of severe OSA, precise evaluations including pharyngeal pressure and fiberscopic examination during sleep as well as a sleep study using an inductive prezysmograph (Respigraph) were performed. Adenoid and/or tonsillar hypertrophy were noted in only 4 children, and the main cause of sleep apnea in the other 6 children was pharyngeal collapse at the lingual base. Their OSA was successfully treated by adenotonsillectomy in 2 children, adenotomy in 2 children, UPPP and lingualplasty in 1 child, tracheostomy in 2 children, and nasal CPAP in 1 child. Before treatment of OSA in CP children, precise evaluation is recommended in order to perform appropriate treatment.

Endovascular papillary angioendothelioma (Dabska tumor) in an elderly woman

A patient with endovascular papillary angioendothelioma with a low grade of malignancy showing papillary proliferation of endothelioid cells is presented. The patient, an 83-year-old woman, underwent resection of a tumor of the neck. At operation a 9 x 7 cm cystic tumor containing yellow transparent liquid with clots was found in the subcutaneous tissue. Histological studies showed endothelioid cells with spindle-shaped nuclei proliferated in layers around the fibrovascular cores, which showed the characteristic appearance of papillary proliferation. These cells were immunohistochemically positive for CD31, CD34 and factor VIII-related antigen. Based on these observations, the tumor was considered to be an endovascular papillary angioendothelioma (Dabska tumor). Dabska tumor is a vascular tumor with a low grade of malignancy and usually occurs in infants and young children. About 13 cases of Dabska tumor have been reported. The occurrence of a Dabska tumor in an aged patient is considered to be rare.

The use of scanning laser ophthalmoscope microperimetry to detect visual impairment caused by macular photocoagulation

BACKGROUND AND OBJECTIVE

To demonstrate the effectiveness of scanning laser ophthalmoscope (SLO) microperimetry in detecting retinal sensitivity and in describing areas of unstable fixation following photocoagulation therapy.

PATIENTS AND METHODS

Two patients with iatrogenic vision loss resulting from photocoagulation therapy underwent a fundus examination, SLO microperimetry, and fluorescein angiography. One patient also underwent indocyanine green angiography.

RESULTS

Two types of visual acuity decrease--sudden-onset and late-onset--were demonstrated following macular photocoagulation, the former resulting from incorrect identification of the fixation point, and the latter from enlarging photocoagulation scars placed in close proximity to the fovea. In one case, SLO microperimetry detected dense scotoma corresponding to the patient's symptoms and an unstable fixation point. In the other case, different retinal sensitivities were found in the photocoagulation scars. No differences were found with fluorescein angiography or indocyanine green angiography.

CONCLUSION

SLO microperimetry might be effective for quantitative assessment of retinal sensitivity in photocoagulation scars and for detecting fixation points and determining their stability.

Effects of cyclosporin A and glucocorticosteroids on antigen-induced hypersensitivity to histamine in a guinea pig model of allergic rhinitis

OBJECTIVE AND DESIGN

In an attempt to study the pathogenesis of mucosal hypersensitivity in allergic rhinitis, we investigated the suppressive effects of cyclosporin A (CyA) and glucocorticosteroids on ovalbumin (OA)-induced hypersensitivity to topical histamine challenge.

MATERIALS

Actively sensitized Dunkin-Hartley guinea pigs.

TREATMENT

OA and alum were applied to guinea pigs intraperitoneally 3 times at two-week intervals. After general sensitization, OA inhalation was performed every day for 6 days as topical sensitization. Before inhalation, treatment with CyA (50 mg/kg, p.o.), glucocorticosteroids (beclomethasone propionate (1.0 mg/kg, i.p.), fluticasone propionate (FP, 0.5 mg/kg, i.p.)) or vehicle were performed, and the sensitivity to histamine was measured before and after the inhalation. Moreover, in actively (general and topical) sensitized guinea pigs, FP (0.5 mg/kg, i.p.) was applied every day for 5 days and histamine sensitivity was evaluated before and after the application.

RESULTS

We found that histamine sensitivity was significantly increased by nasal antigen challenge in this guinea pig model, and that the occurrence of histamine hypersensitivity was inhibited by the pretreatment with CyA and glucocorticosteroids. Although multiple administration of FP gradually reduced the histamine hypersensitivity according to the period of administration, it did not significantly alter the histamine hypersensitivity after the occurrence of hypersensitivity.

CONCLUSION

It is concluded that CyA and glucocorticosteroids suppress antigen-induced histamine hypersensitivity in a guinea pig model of allergic rhinitis.

Human butyrylcholinesterase L330I mutation belongs to a fluoride-resistant gene, by expression in human fetal kidney cells

We noticed a Japanese male showed low serum butyrylcholinesterase (BCHE) activity on health examination. The phenotyping analysis revealed a reduced dibucaine number (DN) and an especially low fluoride number (FN), similar to an FS phenotype. A homozygous missense mutation, a T to A transversion at nucleotide 988, was identified in his BCHE gene. This mutation resulted in the replacement of leucine by isoleucine at codon 330 (L330I). DN and FN of recombinant BCHE(L330I) secreted by human fetal kidney cells were compared to recombinant wild-type(usual gene) BCHE and normal serum BCHE. These results showed this amino acid substitution of BCHE, Leu330 to Ile, really caused the abnormal DN and FN. We conclude that the BCHE L330I mutation is a fluoride-resistant gene, a Japanese type fluoride-resistant gene.

In vitro enhancement of antitumor activity of a water-soluble duocarmycin derivative, KW-2189, by caffeine-mediated DNA-repair inhibition in human lung cancer cells

Duocarmycins, including KW-2189, bind in the minor groove of double-stranded DNA at A-T-rich sequences, followed by covalent bonding with N-3 of adenine in preferred sequences. We examined the effect of DNA-repair modulators, such as caffeine and aphidicolin, on the cytotoxicity of duocarmycins towards human lung cancer cells, as determined by dye formation assay. Caffeine (0.5 or 1 mM), but not aphidicolin, enhanced the growth-inhibitory activity of KW-2189, DU-86, and duocarmycin SA. Caffeine inhibited repair of DNA strand breaks induced by KW-2189, as assayed by the alkaline elution technique. This suggests that duocarmycin-induced DNA strand breaks, which are potentially lethal to cells, are repaired through a caffeine-sensitive pathway.

Detection of antibodies to a recombinant gag protein derived from human endogenous retrovirus clone 4-1 in autoimmune diseases

To investigate whether human endogenous retroviruses (HERV) contribute to autoimmune diseases, we prepared a recombinant p30gag protein derived from clone 4-1 of the HERV family, using a baculovirus-vector system. This p30gag protein (CA41B) was approximately 30 kDa, as expected, and reacted with antibodies for p30gag purified from both murine and feline leukemia virus. This result suggested that the antigenic determinant for p30gag was well conserved in CA41B. Analysis of serum antibodies to p30gag in patients with autoimmune diseases was done by Western blotting. CA41B detected anti-p30gag antibodies in 48.3% of systemic lupus erythematosus (SLE) patients, 35.0% of Sjögren's syndrome (SS) patients, and 33.3% of mixed connective tissue disease (MCTD) patients, whereas no anti-p30gag antibodies were found in healthy subjects. This suggested that HERV p30gag or other retroviral p30gag proteins possessing the same antigenic determinant as CA41B may play a role in these diseases. Although detection of antibodies to HERV p30gag in autoimmune diseases is indirect evidence that HERV proteins are involved, this study showed that patients with autoimmune diseases have antibodies to HERV p30gag using a recombinant HERV protein rather than synthetic peptides based on HERV or retroviral proteins of other species.

Endoscopic papillary balloon dilatation may preserve sphincter of Oddi function after common bile duct stone management: evaluation from the viewpoint of endoscopic manometry

BACKGROUND

Endoscopic papillary balloon dilatation (EPBD) has been reported as a safe and effective alternative to endoscopic sphincterotomy in the management of common bile duct (CBD) stones; its effect on papillary function has yet to be elucidated.

AIM

To investigate sphincter of Oddi (SO) motility before and after EPBD to determine its effect on SO function.

PATIENTS AND METHODS

The papillary function of 10 patients with CBD stones was studied using endoscopic manometry before and one week after EPBD. The manometric studies were repeated one month after EPBD in seven patients.

RESULTS

One week after EPBD, CBD pressure, SO peak pressure, SO basal pressure, and SO frequency decreased significantly. One month after EPBD, however, all parameters increased although the increases in SO basal pressure and CBD pressure were not significant. There was no significant difference in values of any parameter before and one month after EPBD. No serious complications occurred.

CONCLUSION

These data suggest at least partial recovery of papillary function one month after the procedure. EPBD seems to preserve papillary function in treatment of CBD stones; a longer term follow up study with SO manometry should be performed to clarify the effect of EPBD on SO function.

Topical antigen provocation increases the number of immunoreactive IL-4-, IL-5- and IL-6-positive cells in the nasal mucosa of patients with perennial allergic rhinitis

To evaluate the role of Th2-type cytokines in the nasal mucosa which has been repeatedly exposed to antigen, an immunohistological study for IL-4, IL-5 and IL-6 was performed in patients with perennial allergic rhinitis and non allergic rhinosinusitis. The numbers of immunoreactive (ir)-IL-4, ir-IL-5 and ir-IL-6-positive cells were significantly higher in allergic mucosa than in nonallergic mucosa. In allergic mucosa, the numbers of these ir-cytokine-positive cells were significantly higher in the antigen-challenged site than in the control site. When the patients were divided into an early group (4-6 h after challenge) and a later group (15-25 h after challenge), only the change of ir-IL-4-positive cells was remarkable in the former group, whereas those of the ir-IL-4, ir-IL-5 and ir-IL-6-positive cells were significant in the latter group. These results suggest that antigen-induced upregulation of IL-4, IL-5 and IL-6 is important in the pathogenesis of perennial allergic rhinitis.

[Sensorineural hearing loss caused by middle ear surgery]

It is well known that sensorineural hearing loss rarely occurs after middle ear surgery. Five cases of postoperative sensorineural hearing loss were reviewed. These operations amounted to 0.9% of all middle ear operations in which the first author was involved. The causes of hearing loss were believed to be labyrinthitis through the fistula in cholesteatoma case 1, and acoustic trauma from the bone-cutting burr in cases 2 and 3. In cases 4 and 5 postoperative sensorineural hearing loss occurred several months after stapes surgery and the causes of hearing loss were unknown. On the basis of the available literature discussion focused on management of labyrinthine fistula, the acoustic effect of the bone-cutting burr and the possibility of sensorineural hearing loss caused by stapes surgery.

[Inhibitory effects of portal venous injection of type II collagen in collagen-induced arthritis]

Collagen-induced arthritis (CIA) is useful animal model for human rheumatoid arthritis. We investigated the inhibitory effects of portal venous (p.v.) injection of type II collagen (CII) in CIA. The arthritis was suppressed by p.v. injection of CII before immunization for CIA induction. The p.v. route was more effective than intravenous or intragastric routes in the induction of tolerance in CIA. The dose of CII necessary for CIA suppression was 10 micrograms/20 g body weight in p.v. injection. Both anti-CII IgG and anti-CII IgG 2 a levels in serum were reduced in mice injected CII before induction of CIA. However, anti-CII IgG 1 levels did not differ between mice injected with CII and mice injected with buffer alone. Thus, the specific reduction in anti-CII IgG 2 a levels in mice treated by p.v. injection before immunization suggests that the suppression of CIA could be responsible for hypofunction of Th 1 cells. Reduction of anti-CII IgG and suppression of arthritis were observed when CII was injected through portal vein after immunization for CIA as well.

[Systemic lupus erythematosus (SLE) and retrovirus]

Retrovirus have repeatedly been suggested as a possible trigger mechanism for animal and human autoimmune disease. Recent reports indicate that not only exogenous, but also endogenous, retrovirus could play an important role to induce autoimmunity. Here we described the relationship between retrovirus and systemic lupus erythematosus.

Chemohormonal therapy for malignant melanomas of the nasal and paranasal mucosa

We present three cases of primary malignant melanoma of the nasal or paranasal mucosa that were successfully treated by chemohormonal therapy using tamoxifen (TAM), an anti-estrogen agent. All of the patients showed good responses. TAM is widely known to be an anti-estrogen chemotherapeutic agent in the treatment of breast cancer and is thought to exert its anti-neoplastic effect in breast cancer tissues by competing with estrogen for estrogen receptors. The mechanism of the effect of TAM in malignant melanoma is not yet known. Although its anti-neoplastic mechanism requires further exploration, we believe that chemohormonal therapy may become important in multidisciplinary treatment of malignant melanoma of the nasal and paranasal mucosa.

[Familial astrocytoma associated with von Recklinghausen's disease: report of two cases]

Two cases of astrocytoma associated with von Recklinghausen's disease (neurofibromatosis type; NF-1) were reported. The first case wes a 60-year-old man who had been diagnosed as von Recklinghausen's disease on the basis of skin findings. Magnetic resonance imaging (MRI) showed a tumor in the left temporal lobe. Partial removal was performed with neuronavigator, and because of the existence of Rosenthal fiber the histological diagnosis was pilocytic astrocytoma. Radiation therapy was performed. The second case was a 6-year-old boy suffering from headache and left hemiparesis including his face. MRI showed a tumor with a cyst in the right thalamus and obstructive hydrocephalus. Initially CT-guided stereotactic biopsy was performed, and the histological diagnosis, on the basis of increased cellularity, pleomorphism and nuclear atypia without necrosis or vascular proliferation, was anaplastic astrocytoma. Radiation and chemo-immuno therapy were carried out after V-P shunt. It is well known that von Recklinghausen's disease (NF-1) is often associated with optic glioma (5-36%). In the literature, the glioma seldom occurs in other parts of the brain, supratentorial glioma especially is rare. Only two familial cases of supratentorial glioma associated with von Recklinghausen's disease have been reported. The prognosis of supratentorial glioma associated with NF-1 was poor in these reports. In this paper, the diagnostic and therapeutic problems are discussed.

[A case of simultaneous bilateral carotid occlusion]

Cases of bilateral cartoid occlusion have often been reported in the literature, but most of them were not examples of simultaneous bilateral carotid occlusion. Simultaneous bilateral cartoid occlusion appears to be rare, so we report one such case in this paper. A 68-year-old woman suddenly became unconscious, and was delivered to our hospital by ambulance. On arrival, she was comatose and showed decerebrate rigidity upon pain stimulation. Results of CT scan were normal, but cerebral angiography showed bilateral internal carotid artery occlusion at the carotid bifurcation. The patient was treated with urokinase and osmotic diuretics, but these were not effective and she died on the eleventh day after admission. Autopsy revealed that the bilateral internal carotid artery was occluded by fresh thrombi at the carotid bifurcation. The mitral valve was thickened by fibrous adhesion, and this was thought to indicate mitral stenosis. MRI before onset had shown flow void sign in the bilateral internal carotid artery. From the clinical course, and radiological and autopsy findings, we consider this case to be one of simultaneous bilateral carotid occlusion due to cardiogenic thrombi. Previous cases of bilateral carotid occlusion are reviewed and discussed.

[A case of a surgically treated extracranial internal carotid artery saccular aneurysm]

Extracranial internal carotid artery aneurysm is rare. Most cases are due to spontaneous or traumatic dissection of the cervical internal carotid artery. Here we report a case of surgically treated extracranial internal carotid artery (ICA) aneurysm. A 74-year-old man noticed a pulsatile mass just below the left mandibular angle. Intravenous digital subtraction angiography revealed multiple aneurysms in the systemic arteries, including the aortic arch, abdominal aorta and left extracranial ICA. It was decided to treat the aneurysms of the aortic arch and of the abdominal aorta conservatively. Cerebral angiography, however, showed a saccular aneurysm which projected latero-posteriorly at the C2 level of the left extracranial ICA. Although the patient had no previous ischemic event, we decided to treat this aneurysm surgically in view of the risk of cerebral ischemia caused by intraaneurysmal thrombus formation or rupture of the aneurysm by neck injury. The operation was performed under mild hypothermal general anesthesia. Electroencephalography was carried out during the operation. A skin incison was made from the anterior border of the sternocleidomastoid muscle to the pretragal region to expose the parotid gland. This skin incision, elevation of the parotid gland and division of the digastric muscle were useful for exposing the distal portion of the extracranial ICA. After trapping of the aneurysm, it was punctured and collapsed by aspiration and the dome was excised at its neck. The ICA was then reconstructed by suturing the cut neck of the aneurysm. Patency of the ICA was confirmed by postoperative angiography. The postoperative course was smooth except for hoarseness, which was caused by damage to a minor branch of the vagus nerve during exposure of the aneurysmal dome.

Effect of timolol and UF-021 (a prostaglandin-related compound) on pulsatile ocular blood flow in normal volunteers

The effects of topically applied timolol (a nonselective beta-blocker) and UF-021 (a prostaglandin-related compound) on pulsatile ocular blood flow (POBF) were investigated in 9 healthy volunteers. One drop of either UF-021 or timolol was instilled in one randomly selected eye and the fellow eye received physiologic saline. Before and 90 min after drop instillation, we measured intraocular pressure (IOP), POBF, heart rate (HR) and blood pressure (BP). After a washout interval of at least 1 week, the other drug was instilled in the previously treated eye. IOP, POBF, HR, and PB were measured following the same protocol. After timolol administration, IOP and POBF decreased significantly in the treated eye (26%, p = 0.01, and 13%, p = 0.02, respectively) and in the fellow eye (11%, p = 0.01, and 11%, p = 0.03, respectively). HR also decreased (10%, p = 0.03), but BP did not change significantly. After UF-021 administration, no significant changes were found in IOP, POBF, HR, or BP. Our results suggest that in normal subjects timolol decreases POBF in both the treated and the untreated eyes, whereas UF-021 has no action on either IOP or POBF.

Improvement by eicosanoids in cancer cachexia induced by LLC-IL6 transplantation

Cachexia frequently occurs in the late stages of cancer, and is difficult to manage. We previously reported that interleukin-6 (IL-6) cDNA transfection into Lewis lung carcinoma (LLC-IL6) induced cachexia-like symptoms in C57BL/6 mice. This was thought to be a useful experimental model of cancer cachexia. We have examined the effects of two eicosanoids, docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), in order to evaluate whether they could relieve cachexia. LLC-IL6-bearing animals were divided into three treatment groups receiving DHA, EPA or water as the control; 80-microliter samples of these compounds (purity > 95%) were administered orally by catheter daily starting 7 days after tumor transplantation. Tumor growth curves were similar in the three groups. There were no differences in water or food intake in the three groups. However, body weight, a marker of cachexia, was significantly higher in treated mice than in the control group. Sixteen days after tumor transplantation, the mean body weight was 17.45 g (P < 0.05), 17.2 g and 16.41 g in the groups receiving DHA, EPA and water respectively. The eicosanoids did not affect serum levels of IL-6. Ubiquitination of muscle protein, a marker of proteolysis coupled to cachexia, was compared in LLC-IL6- and LLC-transplanted mice. The eicosanoids prevented the ubiquitination of approximately 180 kDa protein. These results suggest that eicosanoids may prevent the cachexia mediated by IL-6.