[Differences between gynecological cancer patients taken care for at home and those taken care for at the hospital]

Thirty-five patients with end-stage gynecological cancer, twelve taken care for at home care and 23 taken care for at our hospital, were compared. The life span after recurrence was significantly (p < 0.05) longer in the group taken care for at home. The number of persons living with the patient was also significantly (p < 0.01) larger in the group taken care for at home. Moreover, the hospitalization in the end stage of the disease was significantly (p < 0.01) shorter in the group taken care for at home. The average hospitalization in the end was for 6.5 days. Four patients died at their home. Average period the 12 patients stayed at home was 52.7 days. Following matters are important in order to provide home care. 1. We must know the biological characteristics of the cancer. 2. It is important that it does not lose the timing to which shift to the home care, keeping good doctor-patient relationship. 3. Limit of the therapy against cancer and importance of treatment at home should be carefully and clearly explained to the patient.

Hypervalent iodine(III)-induced intramolecular cyclization of alpha-(aryl)alkyl-beta-dicarbonyl compounds: a convenient synthesis of benzannulated and spirobenzannulated compounds

A novel hypervalent iodine(III)-induced direct intramolecular cyclization of alpha-(aryl)alkyl-beta-dicarbonyl compounds has been described. Both meta- and para-substituted phenol ether derivatives containing acyclic or cyclic 1,3-dicarbonyl moieties at the side chain undergo this reaction in a facile manner. The reactions afford benzannulated and spirobenzannulated compounds that are of biological importance. The reaction is found to be general, mild, and high yielding. The mechanism of the reaction has been shown to involve a cation radical intermediate.

[Development of intramolecular oxidative phenolic coupling reactions using hypervalent iodine (III) reagents and their application to the synthesis of Amaryllidaceae alkaloids]

Hypervalent iodine (III) reagents nowadays are used extensively in the field of organic chemistry. Especially, phenyliodine (III) diacetate (PIDA) or phenyliodine (III) bis(trifluoroacetate) (PIFA) have received much attention because of their reactivities similar to heavy metal reagents or anodic oxidation, low toxicity, ready availability and easy handling. In the continuous study of our oxidative phenolic coupling reactions using a hypervalent iodine (III) reagents, a versatile synthetic procedure for the galanthamine-type Amaryllidaceae alkaloids was accomplished. The first total synthesis of (+/-)-sanguinine and the total syntheses of (+/-)-galanthamine, (+/-)-narwedine, (+/-)-lycoramine, and (+/-)-norgalanthamine were also successfully carried out.

[Development of novel oxidation reactions using hypervalent iodine reagents and their application to total synthesis of biologically active natural products]

Recently, hypervalent Iodine (III) reagents have been used extensively in organic synthesis. In particular, phenyliodine (III) diacetate (PIDA) and phenyliodine (III) bis(trifluoroacetate) (PIFA) have received a great deal of attention due to low toxicity, ready availability, easy handling, and reactivities similar to that of heavy metal reagents or anodic oxidation. In contrast to the widely explored phenolic oxidation using PIDA or PIFA, reactions of phenol ethers with hypervalent iodine reagents have been limited and have yielded mostly iodonium salts. We found unexpectedly that the reaction of p-substituted phenol ethers with PIFA in the presence of some nucleophiles in polar and poorly nucleophilic solvents such as 2,2,2-trifluoroethanol and 1,1,1,3,3,3-hexafluoro-2-propanol caused a novel and straightforward nucleophilic substitution reaction on the aromatic ring via a cation radical intermediate [ArH+.]. Successful application of PIFA-induced umpolung of electron-rich aromatic ring reactivity allowed intramolecular cyclization reactions of phenol ethers leading to novel and efficient preparations of synthetically useful products such as biaryl compounds, quinone-imines, and sulfur-containing heterocycles. Using these methods, the first total synthesis of potent cytotoxic marine alkaloid, makaluvamine F was also achieved.

Novel catalytic asymmetric sulfoxidation in water using the hypervalent iodine reagent iodoxybenzene

A new catalytic asymmetric oxidation of sulfides to sulfoxides in water using the hypervalent iodine(V) reagent iodoxybenzene (PhIO2) has been developed. This methodology is distinctly different from the previously reported use of cyclodextrins or biological catalysts and provides a new route to asymmetric sulfoxidation in water.

Vector manometric study of the sphincter of Oddi in the dog: functional and morphological correlation

The relationship between sphincter of Oddi pressure and the morphological structure of the sphincter was studied in eight dogs prepared with a duodenal cannula. Sphincter of Oddi manometry was performed in awake animals in three directions, ventral, left dorsal, and right dorsal, using a catheter with three radial side holes for recording at one level. The pressure in the ventral direction (26.6+/-1.06 mmHg) (mean+/-SEM) was significantly lower than that in the left and right dorsal directions (30.6+/-1.42 and 31.2+/-1.23 mmHg, respectively). This functional manometric difference in the three directions correlated closely with the morphological structure of the sphincter of Oddi; the sum of the thickness of the sphincter of Oddi muscle and duodenal proper muscle was greater on the dorsal than on the ventral side. To our knowledge, this is the first report of axial asymmetry in sphincter of Oddi pressure.

Uterine blood flow. Assessment in an intrauterine insemination program for unexplained infertility

OBJECTIVE

To evaluate the diagnostic usefulness of color Doppler velocimetry for infertility treatment.

STUDY DESIGN

Sixty-one women undergoing controlled ovarian hyperstimulation and intrauterine insemination with their husbands' semen due to unexplained infertility were enrolled in the study. The Doppler waveforms of the uterine artery, subendome-trial radial artery and intraovarian artery were analyzed around ovulation, and the calculated pulsatility indices (PIs) were correlated with subsequent pregnancy results.

RESULTS

Those women who conceived exhibited a significantly lower uterine artery PI and higher frequency of positive diastolic blood flow in the subendometrial arteries shortly after ovulation. The PI of the intraovarian arteries prior to ovulation was also significantly lower in conception cycles than in nonconception cycles. Uterine artery PIs between different cycles correlated well in the same individual. Lower uterine artery impedance was noted in women receiving supplementation with human menopausal gonadotropins as compared to clomiphene citrate alone.

CONCLUSION

Doppler velocimetry is a useful tool for evaluating uterine receptiveness in infertility treatment. Intrinsically poor uterine perfusion should be investigated in cases of unexplained infertility.

[A case of advanced breast cancer with multiple lung metastases responding well to postoperative combined administration of doxifluridine (5'-DFUR) and tamoxifen]

A 72-year-old female with right breast cancer having multiple lung metastases was treated by combined administration of 5'-DFUR at 800 mg/day, and tamoxifen, at 20 mg/day, after standard radical mastectomy. Plain chest X-ray and computed tomography examinations have shown complete disappearance of the multiple lung tumor since the therapy. No serious side effects have been observed during the treatment course, and there has been no definite evidence of tumor recurrence.

Squamous cell carcinoma of the splenic flexure of the colon: report of a case

A 51-year-old Japanese man underwent resection of a tumor in the splenic flexure of the colon, which proved to be squamous cell carcinoma. At the time of presentation, the liver was found to have multiple metastases. On the 39th postoperative day, the patient died of liver failure. An autopsy demonstrated metastatic nodules on the pleura and parenchyma of both lungs, as well as in the liver, but failed to show any other primary squamous cell carcinoma. We emphasize that a meticulous search to disprove adenosquamous carcinoma is mandatory before a diagnosis of squamous cell carcinoma of the colon can be confirmed.

[Chemotherapy for advanced and recurrent cancer patients--the effect of combination chemotherapy using cisplatin, peplomycin, mitomycin C, adriamycin, and 5-fluorouracil]

According to the data obtained from the fundamental investigations using flow cytometry we designed the schedule of combination chemotherapy for solid cancer patients and we tried this therapy on 25 patients with non-curative, unresectable and recurrent cancers: 9 gastric, 5 colo-rectal, 3 esophageal, 3 pancreatic, 2 gall bladder, 2 lung and 1 breast cancer. The treatment was performed every 3 or 4 weeks as follows: CDDP 70 mg/m2 (d.i.), PEP 4 mg/m2 (i.v.) and MMC 4 mg/m2 (i.v.) on day 1, ADM 15 mg/m2 (i.v.) on day 4, and 5-Fu 250 mg/body (d.i.) every day. Among 22 patients evaluated completely, 1 complete response, 9 partial responses, 11 no changes, 1 progressive disease were obtained. The overall response rate was 45%. From the comparison of survival curves, survival rate was significantly better in patients responded to this therapy than in patients who did not respond to it (p less than 0.05). As for side effects, myelosuppression occurred in 19 patients (86%), increase of BUN and/or creatinine were observed in 3 patients (14%), increase of GOT and/or GPT were seen in 10 patients (45%), gastrointestinal symptoms and alopecia were observed in almost all patients, but all of these toxicity were transient and did not impede the continuous treatment.

[Experience with transvenous retrieval of a fractured IVH catheter from the superior caval vein--a study of the mechanism of catheter breakage by a model tension test]

An IVH catheter which was left in the superior caval vein was removed using a myocardial bioptome. It was accidentally broken when the patient unintentionally pulled it out. The cut surface was examined and it was confirmed that the IVH catheter could be broken irrespective of any defect of the catheter itself. To clarify the mechanism of catheter breakage, a model tension test was performed. The tensile strength and elongation were examined in 3 ways; first without binding, second with binding, third with binding and also pulling backward. The rate of tension was also varied from 100mm/min to 1,000 mm/min. It was found that the catheter was easier to break when pulled out faster, with binding, and pulled backward. When pulled forward, it was elongated and the site of breakage was not at the site of binding. However, when pulled backward, it was less elongated and the site of breakage was at the site of binding. An electron microscopic examination of the removed catheter revealed that the cut surface resembled that being pulled backward at a rate of 1,000 mm/min. The above suggests that, in this case, the IVH catheter was trapped between the clavicle and the 1st rib and pulled at an angle.

Clinical diagnosis of minute gastric cancer less than 5 mm in diameter

When 58 minute gastric cancers less than 5 mm in diameter from 55 patients were classified into 22 of the single group (minute gastric cancer alone) and 36 of the multiple group (associated with other large gastric cancers), the preoperative correct diagnostic rate by x-ray was 22.7% and 11.1% in the single group and in the multiple group, respectively, with a total rate of 15.5%. The diagnostic rate by endoscopy, aided by endoscopic biopsy, was 95.5%, 13.9%, and 44.8%, respectively. Therefore, it appears that endoscopy and endoscopic biopsy are most efficient diagnostic tools for the detection of such minute gastric cancers. Since the detection of the depressed type (IIc) of minute gastric cancers is considered most significant because of their frequent submucosal invasion, their characteristic endoscopic findings are emphasized: (1) irregular and polygonal shape, (2) distinct depression, (3) clear demarcation, (4) nodular margins, and (5) moth-eaten appearance and abrupt thinning of the mucosal folds.

Intestinal metaplasia of the regenerative epithelia in 549 gastric ulcers

Histopathologic changes in the regenerative epithelia of 549 foci of gastric ulcer were studied. About 70 per cent of the regenerative epithelia revealed intestinal metaplasia of the so-called complete or incomplete type. Parietal cells and chief cells were occasionally observed in the regenerative epithelia of ulcers located in fundic gland areas or at fundopyloric gland borders. It is possible that the regenerative epithelium frequently reverts to intestinal epithelium during the regenerative process, later redifferentiating into normal gastric mucosa or remaining as intestinal metaplasia and that, thus, only a few foci of intestinal metaplasia are precancerous lesions.

[Epidemiologic study of breast fluid in Japanese women]

Breast fluid was collected from 805 Japanese women using a negative-pressure breast-pump procedure. All subjects were non-lactating; there were 275 breast cancer patients and 530 healthy women. Women who secreted 20 microliters or more were classified as "secretors" (290/805, 36%); those who secreted less than 20 microliters to as "non-secretors". Breast cancer patients showed a significantly higher incidence of secretion, particularly in the diseased breast, than healthy women. Among secretors, the risk for breast cancer was high in those with earlier menarche, unmarried women, those with a smaller number of pregnancies and children and those with older age at their first delivery.

Background mucosal changes of primary advanced large intestinal cancer in patients without familial polyposis coli

In 337 cases of primary advanced large intestinal cancer in patients without familial polyposis coli, the risk factor for cancer was discussed chiefly from the background mucosa surrounding and apart from the cancers. The following findings were obtained: (1) in the mucosa surrounding cancers, adenoma was seen in 23 cases (6.8 per cent), adenomatous changes of the basal cells in 211 cases (62.6 per cent), and hyperplastic glands in 167 cases (49.6 per cent), (2) in the mucosa at least 10 mm from the cancers, adenoma, adenomatous changes of the basal cells, and hyperplastic glands were seen in 42 cases (12.5 per cent), 129 cases (38.3 per cent), and 40 cases (11.9 per cent), respectively. Therefore, it is suggested that microscopic adenoma and adenomatous changes of the basal cells might be a sign of premalignancy in patients without familial polyposis coli.

Minute gastric cancers less than 5 mm in diameter

Minute gastric cancers with maximum dimensions of less than 5 mm were studied clinicopathologically. There were 49 intramucosal cancers among 46 patients and nine submucosal cancers among nine patients. No lymph node metastasis was found. Macroscopically, eight (13.8%) were evaluated, 12 (20.7%) were flat, and 38 (65.5%) were depressed. Most submucosal cancers were of the depressed type (8/9, 88.9%). Classification of cancers according to association with other large cancers into single group (22 cases) and multiple group (33 cases) revealed that (1) the majority of the minute gastric cancers (20/22, 90.9%) in the single group were the depressed type and (2) submucosal cancers in the single group were 8/22, accounting for 36.4%, a much higher incidence as compared with 1/36 (2.9%) in the multiple group. These facts indicate that gastric cancers should be detected when they are about 5 mm in maximum dimension and before they invade beyond the submucosal layer, especially in single and depressed type.

Comparative study of familial polyposis coli and nonpolyposis coli on the histogenesis of large-intestinal adenoma

The entire length of the large intestine resected from six patients with familial polyposis coli (FPC) was step-sectioned, and microscopic adenomas composed of one to several glands were prepared into complete serial sections. Histopathologic comparison of these microscopic adenomas was made between FPC and nonpolyposis coli (those not included in the special disease group of FPC). The histogenesis of adenomas in FPC and nonpolyposis coli was considered as follows. (1) In nonpolyposis coli, adenomas arise from basal cells of the deep layer of the mucosa. (2) In FPC, most of the adenomas (81.2 per cent) arise in the same manner as described above, although there are some (18.8 per cent) that appear to have arisen in the middle or superficial layer of the mucosa. (3) Therefore, it is believed that the morphologic difference of the large-intestinal mucosa between FPC and nonpolyposis coli comes not from the difference in the number of adenomas present but from the difference in the position and/or timing of appearance of adenomas.

Histogenesis of microscopic adenoma and hyperplastic (metaplastic) gland in nonpolyposis coli

Histogenesis of microscopic adenoma in nonpolypoid colons (those not included in the special disease group of familial polyposis coli) was investigated using complete serial sections with the following results: Adenoma arises from basal cells in the deep layer of the mucosa; and two types of basal cells found were 1) those which had already undergone changes to adenoma and 2) those which are in their transitional stage to adenomas. Early-phase growth of adenoma is brought about by branching. Individual hyperplastic (metaplastic) glands constituting so-called hyperplastic (metaplastic) polyps are considered to be only an expression of one variant in the growing process of adenomas and the glands showing these changes most characteristically have a serrated pattern. Based on these findings, the histogenesis of adenoma in nonpolypoid colons is shown schematically.

Microscopic adenoma in nonpolyposis coli: incidence and relation to basal cells and lymphoid follicles

Six microscopic adenomas found in four patients of nonpolyposis coli (namely, not included in the group of familial polyposis coli) which had been detectable microscopically but not macroscopically, were examined by preparing complete serial section. With respect to the histogenesis of large-intestinal adenomas in nonpolyposis coli, they are considered to originate from the basal cells. As the background for this, a great number of adenomatous changes in basal cells were seen, and the microscopic adenomas showed a tendency of multiplicity (in the present study a total of 36 microscopic adenomas were detected). The above-described adenomatous changes in basal cells and development of microscopic adenomas are considered to be closely related to lymphoid follicles on the muscularis mucosa, with 20 (55.6 per cent) of 36 microscopic adenomas originating in the basal cell upon the lymphoid follicles.

Studies on the difference of background mucosa among single advanced carcinoma and benign diseases of the large intestine, and familial polyposis coli

The entire lengths of fixed specimens from 17 single advanced carcinomas of the colon (Cancer Group), four benign lesions (Benign Group), and four familial polyposis coli (Polyposis Group) were step-sectioned. It was found that the tubules of the basal cells were densely packed with rather a small number of goblet cells in the cancer and benign lesion specimens, but clear and loose with completely differentiated goblet cells in the polyposis coli specimens. Microscopic adenomas that were macroscopically unrecognizable and only microscopically detectable were found in 16 lesions in the Cancer Group, one lesion in the Benign Group, and in numerous lesions in the Polyposis Group. All of them developed from the basal cells. These findings indicate that the colonic mucosa of patients in the Cancer and Benign Groups is similar, but differs from that of the Polyposisis Group, and that microscopic adenomas are not uncommon in the Non-Polyposis Groups (Cancer and Benign Groups), findings which were not previously known.