[Long-term survival of stage D2 prostatic carcinoma patient treated with total cysto-prostatectomy: a case report]

A 52-year-old male was admitted to this hospital as stage D2 prostatic carcinoma. He had been previously treated with transurethral resection of prostate and hormonal therapy. Rectal examination revealed the prostate bigger than a hen-egg with stony-hard nodules. Both whole body bone X-ray and bone scintigram showed multiple bone metastasis. Total cysto-prostatectomy and pelvic lymph node dissection were performed because the patient was relatively young, was in good general status and the tumor was not sensitive to hormonal therapy. In addition, he was expected to have obstructive uropathy soon and the reported results of radiotherapy for local control of advanced prostate cancer were unsatisfactory. He was followed by bone X-ray and bone scintigram every six months. Osteoplastic area diminished in size and hot lesions in bone scintigram disappeared gradually. The patient is very active in his daily life without evidence of local recurrence or new metastasis more than seven years after operation. The validity of mass reduction surgery for hormone-resistant stage D2 prostatic carcinoma is discussed.

Coexistence of papillary and nodular carcinomas in the urinary bladder

Of 203 patients with transitional cell carcinoma of the urinary bladder which had been cystectomized and examined by step-sectioning during the period between 1969 and 1986, 33 had coexistent papillary, papillonodular and/or nodular carcinomas in the bladder. Of them, 12 (36%) had a history of papillary carcinomas, 26 (79%) had multiple tumors and 22 (67%) had a concomitant carcinoma in situ, and/or mucosal dysplasia. Moreover, microscopic papillary structures were identified in 32 out of the 33 (97%) cases with papillonodular and/or nodular carcinomas, indicating some of the nodular invasive carcinomas in the bladder to have developed from papillary carcinomas.

Thymic enlargement following treatment for a metastatic germ cell tumor: a case report

We describe a patient with metastatic testicular carcinoma in whom an anterior mediastinal mass developed 8 months after complete remission following chemotherapy and surgery. The mass was excised and pathological examination showed benign thymic hyperplasia. An anterior mediastinal mass encountered after successful chemotherapy does not always imply recurrence or relapse of malignant disease. The possibility of a benign etiology must be considered to prevent inappropriate treatment.

Analyses of avidin-biotin complexes with lectins of membrane glycoproteins in the urinary bladder of rats treated with N-butyl-N-(4-hydroxybutyl)nitrosamine

The bladder epithelium was examined by staining with avidin-biotin complexes with lectins to determine the early membrane changes during bladder carcinogenesis in rats treated with N-butyl-N-(4-hydroxybutyl)-nitrosamine (BHBN). Concanavalia ensiformis (Con A), Triticum vulgaris (WGA), Ricinus communis (RCA) and Arachis hypogaea (PNA) were used as probes. The cellular distributions of lectin particles were distinguished into membranous and cytoplasmic patterns. Normal bladder cells stained very slightly and showed a spotty membranous pattern. After treatment of rats with BHBN for two or three weeks, staining became stronger and its pattern changed from a membranous to a cytoplasmic type. The staining of bladder cancer cells induced by BHBN varied from area to area and with different lectins. These data indicated that changes in carbohydrates occur in the bladder cell membrane during the early phase of carcinogenesis.

[High performance liquid chromatographic determination of astromicin and cefsulodin used in combination in blood samples]

Aminoglycoside and beta-lactam antibiotics are often used in combination. This paper reports a high performance liquid chromatographic determination method for each of astromicin (ASTM) and cefsulodin (CFS) in blood samples of several species. The procedure for ASTM included purification with CM-Sephadex, separation on a reversed phase column (C-18) and derivatization with o-phthalaldehyde (OPA). The procedure for CFS included deproteinization with methanol, centrifugation, filtration and separation on a reversed phase column (C-18). Either of the drugs did not affect the determination of the other. The detection limits were 0.1 microgram/ml for ASTM and 0.5 microgram/ml for CFS. These sensitivities seem good enough for a clinical application of the method considering usual dosage levels of the drugs.

[High performance liquid chromatographic determination of astromicin and cefoperazone used in combination in blood samples]

Combination therapy of aminoglycoside and beta-lactam antibiotics is often used clinically because of its effectiveness. This paper reports a high performance liquid chromatographic (HPLC) determination method for each of astromicin (ASTM) and cefoperazone (CPZ) in blood samples of several species. The procedure for ASTM included purification with CM-Sephadex, separation on a reversed phase column (C-18) and derivatization with o-phthalaldehyde (OPA). The procedure for CPZ included deproteinization with methanol, centrifugation and separation on a reversed phase column (C-18). Either of the drugs did not affect the determination of the other. The detection limits were 0.1 microgram/ml for ASTM and 0.5 microgram/ml for CPZ. These sensitivities seem good enough for a clinical application of the method considering usual dosage levels of the drugs.

[High performance liquid chromatographic determination of astromicin and piperacillin used in combination in blood samples]

Aminoglycoside and beta-lactam antibiotics are often used in combination, and many synergistic effects have been reported. We describe here a high performance liquid chromatographic determination method for each of astromicin (ASTM) and piperacillin (PIPC) in blood samples of several species. The procedure for ASTM included purification with CM-Sephadex, separation on a reversed phase column (C-18) and derivatization with o-phthalaldehyde (OPA). The procedure for PIPC included deproteinization with acetonitrile, centrifugation and separation on a reversed phase column (C-18). Either of the drugs did not affect the determination of the other. The detection limits were 0.1 microgram/ml for ASTM and 0.5 microgram/ml for PIPC. These sensitivities seem good enough for a clinical application of the method considering usual dosage levels of these drugs.

Interferon enhances tryptophan metabolism by inducing pulmonary indoleamine 2,3-dioxygenase: its possible occurrence in cancer patients

Human lungs bearing cancer (n = 27) exhibited up to an approximately 20-fold [on average approximately 5-fold (P less than 0.005)] increase in the enzyme activity that degrades tryptophan to form formylkynurenine, in comparison with lungs with benign lesions (blebs) (n = 7) taken as controls. On the basis of molecular and kinetic properties, this activity was ascribed to indoleamine 2,3-dioxygenase (IDO) [indoleamine:oxygen 2,3-oxidoreductase (decyclizing)]. In vitro studies with human lung slices revealed that human interferon gamma (IFN-gamma) induced the de novo synthesis of IDO dose dependently (10-10(4) units/ml), and at maximum the activity reached nearly 100 times that in the control lungs described above. Human IFN-alpha also served as an inducer, but it was two to three orders of magnitude less potent than IFN-gamma relative to the antiviral titers, suggesting that IFN-gamma is the main mediator of the IDO induction. IDO thus induced in slices avidly metabolized tryptophan in situ: Upon a 24-hr incubation of lung slices pretreated with varied doses of IFN-gamma (10-10(3) units/ml), up to 96% of the tryptophan in the slices was depleted and up to 70% of the tryptophan in the medium was converted, mainly to formylkynurenine, kynurenine, or both. The foregoing results suggest that an IFN-mediated induction of IDO also takes place in vivo in human lungs as a response to cancer, leading to metabolic consequences such as depletion of tryptophan and accumulation of (formyl)kynurenine, which may provide a unique host defense mechanism.

[Arteritis and fatty degeneration of the spermatic cord resembling periarteritis nodosa: a case report]

A 23-year old male was admitted to our hospital because of swelling of the left scrotum for one month without any particular past history. Blood count, chemistry, urinalysis, chest X-ray and electrocardiogram revealed normal findings. Scrotal exploration was performed. A soft, dumbbell-like tumor enveloped in a thin membrane was found above the left testis. Pathology revealed fibrinous exudation and fibrinoid necrosis in the whole vessel wall indicating resemblance to the panarteritis in periarteritis nodosa. Some granulomatous lesions with many histiocytes were also noted around these arteries. The findings suggested that a inflammation like periarteritis nodosa had occurred at the spermatic cord and subsequently developed into fatty degeneration in the surroundings. Since local periarteritis nodosa-like lesion may progress to systematic disease, further observation is mandatory for this case.

Application of hyperthermia to the treatment of human acute leukemia: purging human leukemic progenitor cells by heat

The application of hyperthermia to the treatment of neoplastic disease has focused on solid tumors. Since the hyperthermic sensitivity of human acute leukemia cells is not known, we have studied the in vitro response of human leukemic progenitor cells (L-CFU) to hyperthermia using a quantitative assay system for L-CFU. Human L-CFU were found to be more sensitive than committed normal myeloid progenitor cells to hyperthermic killing (41 to 42 degrees C). In addition, in the five acute myelogenous leukemic patients studied, it was shown that their leukemic progenitor cells--all types were studied according to the French-American-British diagnosis--were unable to form colonies when exposed to a temperature of 42 degrees C for 60 minutes, whereas the residual normal clones suppressed by the leukemic cell population were found to recover and to form more colonies in vitro as compared with untreated leukemic marrows. This strongly suggests that in vitro hyperthermia may selectively purge residual leukemic cells, especially L-CFU in stored remission bone marrow before autologous bone marrow transplantation.

[Computed tomography for the diagnosis of a renal mass]

The accuracy of differential diagnosis of renal mass lesions by computed tomography (CT) was evaluated. A retrospective study was done on 23 patients with renal mass lesion suspected by conventional IVP. Cases studied included 6 renal cell carcinomas, 1 nephroblastoma, 2 transitional cell carcinomas of renal pelvis, 3 parapelvic cysts, 2 polycystic kidneys and 9 other benign renal lesions. CT, especially with enhancement, is advantageous for evaluation of the extent of the tumor and also for the differentiation between cystic and solid masses by their attenuation. However, angiography and venography could provide valuable information for surgery of malignancy; and, retrograde pyelography also would help in assessing the extent of tumor spread in the renal pelvis. Two of our cases of parapelvic cyst and a case of renal bleeding could not be distinguished accurately by CT. Sonography or other diagnostic procedures might be helpful in such cases.

[Cytotoxic activity of large granular lymphocytes (LGL) infiltrated into metastatic tumors of lung cancer]

Large granular lymphocytes (LGL) showing Leu 7 and weak E rosettes were separated from two metastatic tumors of lung cancer. Weak cytotoxic activity of these cells was recognized against autochthonous tumors, but never against K-562 cells. After OK-432 therapy, this cytotoxicity was not enhanced, but antibody dependent cell-mediated cytotoxicity (ADCC) of peripheral blood mononuclear cells of the patient was induced against metastatic tumors. These signs may suggest that specific immunotherapy should be available for these cancers.

Food constituents as a cause of variation of C-peptide excretion in the urine

Since C-peptide immunoreactivity (CPR) is excreted at a much higher rate than insulin in the urine, the urinary CPR (U-CPR) level could be a good measure of pancreatic B-cell function. In 10 normal subjects and 17 patients with non insulin-dependent diabetes mellitus (NIDDM), the 24-hour U-CPR level was 49.6 +/- 4.5 (mean +/- SE) micrograms, and 59.1 +/- 7.9 micrograms, respectively. When measured repeatedly during 4-37 consecutive days, the mean levels of coefficient of variation (c.v.) of 24-hour U-CPRs in each individual in normal and diabetic patients were 23.4 +/- 3.2%, and 39.1 +/- 1.2%, respectively. Thus, the daily fluctuation of U-CPR was considerably large not only in NIDDM but also in normal healthy subjects. In order to investigate factors responsible for these U-CPR variations, we analyzed the effect of food constituents on U-CPR excretion in this paper. In 8 healthy subjects 5-hour U-CPR excretions were measured after ingesting 5 kinds of isocaloric 300 kcal test meals, i.e. glucose, starch, protein, fat, and mixed meal which consisted of equal kcal of starch, protein and fat. Five hour U-CPR excretion after glucose, starch and protein meal ingestion was 9.5 +/- 1.3 micrograms, 13.7 +/- 1.9 micrograms, and 7.4 +/- 0.9 micrograms, respectively. Fat meal induced no increase in U-CPR excretion. After the mixed meal ingestion, 5-hour U-CPR was 8.2 +/- 0.6 micrograms, which was approximately the mathematical average for the U-CPR after 3 meals. We conclude that the cause of variations in the U-CPR excretion may be ascribed not only to the ingested total calories, but also to the nutritional components of the diet. Therefore, care must be taken in reading a daily U-CPR measurement in assessing pancreatic B cell function.

[Squamous cell carcinoma of the bladder--report of two cases]

Two cases of squamous cell carcinoma of the urinary bladder are presented. Initial pathologic diagnosis was based on biopsy findings; it was confirmed by findings on resected specimens. Since aggressive surgical therapy has been reported to be successful, we attempted radical surgery in both of our patients. A 76-year-old woman underwent total cystectomy with resection of segments of rectal and vaginal walls with ureterocutaneostomy and colostomy. The other patient, a 66-year-old woman was inoperable due to wide tumor invasion. She died two months later of cerebrovascular accident apparently unrelated to original disease. The ultrastructural findings, which typically show numerous tonofilaments, ribosomes and desmosomes, are presented and discussed.

Enzymatic dehydrogenation of tryptophan residues of human globins by tryptophan side chain oxidase II

Enzymatic dehydrogenation of tryptophan residues in human alpha- and beta-globins has been demonstrated with tryptophan side chain oxidase II, a hemoprotein from Pseudomonas. In 1 M ammonium acetate, pH 4, the enzyme catalyzed the conversion of Trp-14 of alpha-globin to alpha, beta-dehydro-Trp. Under identical conditions, Trp-15 of beta-globin was converted to alpha, beta-dehydro-Trp, whereas Trp-37 was unmodified. No modification was obtained in 0.4% sodium dodecyl sulfate or 8 M urea. The dehydrogenase component of tryptophan side chain oxidase II was also active toward globins in the presence of ferricyanide, whereas tryptophan side chain oxidase I was inert. Upon analyses of the tryptic fragments of the modified beta-globin, two forms of alpha, beta-dehydro-Trp-15 distinguishable by ultraviolet absorption and fluorescence were identified. Each of them rapidly equilibrated with another form on irradiation at 300-380 nm. We tentatively assigned them to two isomers of alpha, beta-dehydro-Trp distinguishable by the configuration around its beta-carbon atom. alpha, beta-Dehydro-Trp in globins and certain polypeptides used herein showed a blue fluorescence at 420 nm. In [alpha, beta-dehydro-Trp 15]beta-globin, the fluorescence was exceptionally intense, the fluorescence yield being comparable to that of NADH. From several lines of evidence, the result was ascribed to the excitation energy transfer from Trp-37 to alpha, beta-dehydro-Trp-15 in the modified beta-globin.

Prevalence of diabetic retinopathy and distribution of its severity among patients of a university clinic of diabetes in Osaka

We have been following longitudinal changes of diabetic retinopathy by periodic fundoscopy in patients at our out-patient clinic for diabetes mellitus. In this study, we reviewed the prevalence of diabetic retinopathy and the distribution of its severities. Funduscopic examinations for retinopathy were performed on 242 patients. They ranged in age from 13 to 84 years (52.9 +/- 0.9, mean +/- s.e.). Duration of diabetes ranged from 1 to 31 years (10.7 +/- 0.4). Forty patients were treated with diet alone, 112 with oral hypoglycemic agents and 90 with insulin administration. No retinopathy was found in 83 patients (34%), background retinopathy in 113 (47%), preproliferative retinopathy in 24 (10%) and proliferative retinopathy in 17 (7%). Five patients (2%) were blind. Twenty-seven patients (60%) of 45 with a less than 5-year duration of diabetes were apparently without retinopathy, while the incidence of proliferative retinopathy increased in proportion to the duration. Fasting plasma glucose and glycosylated hemoglobin levels were higher in the patients with proliferative retinopathy than in any other group. All of the blind patients had a long history of untreated diabetes. Whether diabetic control assessed by glycosylated hemoglobin influences the progression of retinopathy could not be demonstrated by a 2-year observation. Further analysis based on a longer duration is needed in this respect.

[Synchronous double cancer of the esophagus and the urinary bladder: report of two cases]

An 82-year-old man was seen with the complaints of gross hematuria and dysphagia in September 1979. An invasive bladder tumor was found and TUR-Bt (Transitional cell carcinoma, G2, pT3NXMO ) was performed. Fluoroscopic examination revealed a large esophageal cancer (Undifferentiated squamous cell carcinoma, T2NXMO ) and irradiation was performed (Linac 4,600 rads). The patient's condition aggravated rapidly and he died in February 1980. A 76-year-old man irradiated for an esophageal cancer (Linac 6,540 rads) (undifferentiated squamous cell carcinoma, T1NXMO ) in March 1981. Eleven months later, bladder cancer was found and treated with TUR-Bt (Transitional cell carcinoma, G2, PTlmNXMO ) followed by intravesical instillation of carboquone and adriamycin. The patient was alive 1 year and 9 months after the diagnosis of the esophageal cancer. Sixteen cases of double cancer of the esophagus and urinary bladder were found in the Japanese literature. Eighteen cases including the above 2 cases were males and their ages ranged from 51 to 82 years. Sixteen bladder cancers were transitional cell carcinoma and 15 esophagus cancers were squamous cell carcinoma. Of 9 cases whose clinical course were described in detail, 3 were synchronous and 6 were metachronous. Radical surgery was performed for one or both of the two cancers in 5 cases, 4 of which were metachronous. Indication of surgery for the metachronous second cancer does not differ significantly from sporadic cancer when the first cancer has been managed successfully. However, the treatment for the synchronous double cancer of this type of combination is often forced to be restricted, since the prognosis of esophageal cancer is poor and surgical risk may be increased by two radical surgeries in such elderly patients.

Picomole analyses of tryptophan by derivatization to 9-hydroxymethyl-beta-carboline

A new method specific for the determination of subpicomole quantities of tryptophan has been developed by elaboration of the Pictet-Spengler reaction. It permitted reproducible quantitation of tryptophan in less than 1 microliter of plasma ultrafiltrate or 1 mg of brain tissue. Samples deproteinized by trichloroacetic acid were boiled for 15 min with formaldehyde and potassium ferricyanide at controlled acidity, where tryptophan was converted to a single new product identified as 9-hydroxymethyl-beta-carboline. It was quantitated by either direct spectrofluorometry or a reversed-phase HPLC system developed for beta-carbolines. Under our conditions, peptides containing N-terminal tryptophan such as Trp-Leu and delta sleep-inducing peptide gave N-(9-hydroxymethyl-beta-carboline-3-carbonyl) peptides which retained all amino acid residues except tryptophan.

[An in vitro chemotherapy sensitivity test on leukemic colony-forming cells (L-CFU) and its clinical evaluation]

The sensitivity of leukemic progenitor cells (L-CFU) to cytosine arabinoside (Ara-C) and daunomycin (DM) in vitro was studied using PHA -LCM two step assay for L-CFU. Continuous exposure of leukemic and normal bone marrow cells to DM as well as Ara-C in vitro appeared to be more effective than pulse exposure because colony formation was suppressed by a dose dependent fashion. The relationship between in vitro sensitivity to DM and Ara-C and that of in vivo to chemotherapy was investigated in 17 untreated and 5 relapsed patients with acute nonlymphocytic leukemia. The sensitivity of L-CFU to the two chemotherapeutic agents varied from patient to patient. These studies indicated a clear-cut relationship between in vitro drug sensitivity and in vivo response to patients whose L-CFU were sensitive to both agents and entered complete remission, whereas patients whose L-CFU were insensitive to one or both drugs in vitro failed to enter remission. This assay system appears to be useful in predicting response of patients to chemotherapy and in selecting the most effective drugs for an individual patient use.

[Therapeutic results of DCMP therapy (2M-80) in acute non-lymphocytic leukemia--the relationship between the residual leukemic cells and duration of remission]

In this study the duration of complete remission by daunomycin, cytosine arabinoside (Ara-C), 6MP and prednisolone (DCMP) therapy using a large dose of Ara-C (200 mg) (protocol 2M-80) was compared with that of DCMP therapy with a low dose of Ara-C (80-160 mg) in acute non-lymphocytic leukemia (ANLL). In protocol 2M-80, the chemotherapy was continued until leukemic blasts in marrow were attained below 3%. Complete remission was induced in about 80% of ANLL patients in both chemotherapies. However, the duration of remission in protocol 2M-80 appeared to be much longer than that of DCMP therapy with a low, dose of Ara-C. This difference was dependent not on the consolidation and maintenance therapy, but on the total dose of Ara-C used and leukemic blasts left in marrow at the end of chemotherapy. This suggests that it is important to reduce leukemic blasts in marrow as low as possible by induction chemotherapy to obtain a long-term remission in ANLL.

[Infections during induction chemotherapy of acute leukemia and their control V. Clinical evaluation of a large dose of amikacin injected intravenously]

In this study, we treated severe infections (21 cases) accompanied with induction chemotherapy in 20 patients with acute leukemia by the combination of a large dose (600 approximately 1,200 mg/day) of amikacin with other antibiotics. Infections during induction chemotherapy of acute leukemia consisted of sepsis (8 cases), pneumonia (7) and others (6), and most of causative organisms were Gram-negative bacteria, such as Ps. aeruginosa (7 strains), Flavobacterium (5), Serratia (3), Ps. cepacia (2), E. coli (2) and others. The combination chemotherapy of a large dose of amikacin with other antibiotics was found to be effective (71.4%) for such infections. Side effects were negligible except for drug eruption. Therefore, a large dose of amikacin should be given for the treatment of severe infections accompanied with induction chemotherapy of acute leukemia.

Neurotensin and substance P and dumping syndrome

To investigate the pathophysiological relation between releases of gut hormones and dumping syndrome, plasma radioimmunoassayable neurotensin, substance P, glucagon-like immunoreactivity (GLI), insulin and blood sugar were measured in both gastrectomized patients and control subjects after 50 g oral glucose tolerance tests. Remarkable rises of radioimmunoassayable neurotensin and GLI were found in all gastrectomized patients, but not in control subjects. In contrast, plasma radioimmunoassayable substance P responses were not detected in either gastrectomized patients or control subjects. There were three patients with symptoms of dumping syndrome in the early stage of the test. Plasma radioimmunoassayable neurotensin responses in two out of these three were higher than those in other patients, though the other patient with symptoms had the same degree of neurotensin elevation as patients with no symptoms. In view of the pharmacological effects of neurotensin, it could not be ruled out that a part of the early symptoms of dumping syndrome may result from the remarkably enhanced plasma neurotensin release in some patients, although the enhanced neurotensin responses did not always accompany symptoms of dumping syndrome.

Enzymatic modification of tryptophan residues by tryptophan side chain oxidase I and II from Pseudomonas

The enzymatic modification of tryptophan residues in Trp-Leu, Leu-Trp, Leu-Trp-Leu, and yeast mating hormone (alpha-factor), a tridecapeptide containing Trp-1 and Trp-3, has been investigated with tryptophan side chain oxidase I crystallized previously from Pseudomonas and tryptophan side chain oxidase II recently isolated from the same organism. With Trp-Leu as substrate, threo- and erythro-beta-hydroxytryptophan residues were identified as primary products and the former perferentially underwent second step dehydrogenation to give beta-ketotryptophan. Free threo- and erythro-beta-hydroxytryptophan, hitherto undescribed tryptophan derivatives, were isolated after enzymatic hydrolysis, identified, and characterized. Leu-alpha, beta-dehydrotryptamine, a new biochemical entity, was a sole main product of Leu-Trp. With Leu-Trp-Leu, diastereoisomeric Leu-beta-hydroxyl-Trp-Leu and Leu-alpha, beta-dehydro-Trp-Leu were formed simultaneously, the pH and ionic strength being determinants of the ratio of these products. Leu-threo-beta-hydroxy-Trp-Leu was also converted to Leu-beta-keto-Trp-Leu, but, distinct from NH2-terminal beta-hydroxytryptophan, both diastereoisomers underwent acid-catalyzed dehydration to give Leu-alpha, beta-dehydro-Trp-Leu. Thus, the mode of modification was shown to be prescribed by the site of tryptophan in peptides and the results were the same with either tryptophan side chain oxidase I or II, except that the latter was almost inactive on Trp-Leu. With any substrate, 3-indolecarboxaldehyde was a sole detectable by-product.