A new successful therapy for fetal chylothorax by intrapleural injection of maternal blood.

We present two cases of fetal chylothorax and hydrops diagnosed at 20 weeks' gestation, both of which underwent successful intrauterine treatment. In Case 1, a transient, near total resolution began 2 weeks after an iatrogenic hemothorax following a second thoracocentesis performed at 24 + 6 weeks. Because of pleural fluid reaccumulation, a Cesarean section was performed at 36 weeks. The 3805-g female neonate was admitted to neonatal intensive care but was discharged 50 days later in a healthy condition. In Case 2, resolution occurred after a third thoracocentesis and a second pleural injection of maternal blood, performed at 26 weeks. A 2660-g female neonate was delivered vaginally at 38 weeks. The infant remained asymptomatic and was discharged aged 4 days. Our experience suggests a possible useful role of intrapleural blood injection for the treatment of fetal chylothorax.     

Treatment of severe fetal chylothorax associated with pronounced hydrops with intrapleural injection of OK-432.

We describe a case of a 25-week fetus with severe bilateral pleural effusion, marked ascites, skin edema, an anterior thick (hydropic) placenta and polyhydramnios in which the most probable diagnosis was congenital chylothorax. Treatment with a pleuroamniotic shunt was planned, however the location of the fetus just below the anterior placenta made the placement of the shunt too dangerous. We therefore decided to use intrapleural injection of OK-432. From week 29, the lungs looked normal, the pleural effusion had resolved and the thoracic circumference was within normal limits. The severe ascites persisted throughout the pregnancy and a total volume of 3680 mL was removed on several occasions. A Cesarean section was performed at 38 weeks and a normal male was delivered. Continuous positive airway pressure was needed on the first 4 days but after a week the situation was stable. On day 8, an X-ray showed normally developed lungs. OK-432 appears to have prevented pulmonary hypoplasia in our patient.     

A new fetal therapy for chylothorax: pleurodesis with OK-432.

We present a case of pleurodesis by intrapleural injection of OK-432 for the treatment of fetal chylothorax at an early gestational age. OK-432 injection achieved rapid and effective control of pleural effusion with no adverse effects.     

Augmentation by OK-432 of generation of culture-induced killer cells

A streptococcal preparation, OK-432, injected intraperitoneally, potentiated rejection of L1210 leukemic cells in semiallogeneic BALB/c mice. This increased rejection was further enhanced by a transfer of peritoneal exudate T (PET) cells, but not of spleen cells. Spleen cells incubated in vitro for 3 or more days were as effective as PET cells in stimulating tumor rejection, and were cytotoxic in vitro as tested by a 4-hr 51Cr-release assay. This cytotoxicity was closely related to the OK-432-mediated augmentation of L1210 rejection in vivo. In vitro treatment with OK-432 of spleen cells from intact mice generated nonspecific cytotoxic cells. The cells were nonadherent to plastic, radioresistant, and of Thy-1+, Lyt-1,2-, and asialoGM1+ phenotypes, and were tentatively named OK-432-induced killer (OIK) cells. They were cytotoxic to tumor cells resistant to natural killer (NK) cells, and different from NK cells or lymphokine-activated killer cells. For their generation, macromolecular synthesis and participation of plastic-adherent cells (probably macrophages) were needed. The in vivo growth of L1210 leukemic cells could not be inhibited by simultaneous administration of PET cells primed in vivo with OK-432, of spleen cells primed in vivo with OK-432 and then cultured, or of spleen cells primed in vitro with OK-432 and then cultured (OIK cells). However, a prophylactic adoptive transfer of these cells was effective in immunocompetent mice as well as in athymic nu/nu mice, but not in mice irradiated with 400 rad. The in vivo activity was attributable mainly to Lyt-1+, -2- cells radioresistant and adherent to nylon wool, which were probably amplifier/helper T cells.     

Enhanced generation of OK-432-induced killer cells by interleukin 2

Spleen cells of untreated mice became nonspecifically cytotoxic after cultivation in the presence of a streptococcal preparation, OK-432, for 3 or more days. The cytotoxic cells, named OK-432-induced killer (OIK) cells, injured a variety of target cells including syngeneic EL-4 cells resistant to natural killer (NK) cells, but not NK-susceptible YAC-1 cells. C57BL/6 splenic cells cultured for 5 days in the presence of both OK-432 and interleukin 2 (IL-2) were highly cytotoxic to both EL-4 and YAC-1 cells, and had Thy-1+, Lyt-1,2-, and asialogGM1+ phenotypes, which were identical with those of OIK cells. A test for competitive inhibition with cold target cells and fractionation by centrifugation onto discontinuous density gradients of Percoll showed that cytotoxic cells generated by OK-432 plus IL-2 comprised at least two populations; the cells in the first population were cytotoxic to EL-4 cells but not to YAC-1 cells, and were smaller in size than those in the second population, which were cytotoxic to YAC-1 cells and had NK morphology. Therefore, generation of OIK cells was augmented by IL-2.     

Antenatal diagnosis of congenital chylothorax by gray scale sonography.

In a patient with hydramnios, fetal hydrops was diagnosed by B mode ultrasound. Gray scale sonography visualized fluid in the fetal pleural cavity. The diagnosis (congenital chylothorax) was confirmed at autopsy.     

胸腔闭式引流联合注射沙培林治疗恶性胸腔积液的护理

总结16例胸腔闭式引流联合胸腔内注射沙培林治疗恶性胸腔积液的护理。认为护理重点是加强心理护理、保持有效引流、正确拔管、不良反应的观察和护理。16例中完全缓解12例、部分缓解3例、无效1例。     

A randomized controlled study of immunochemotherapy with OK-432 after curative surgery for gastric cancer

The effect of adjuvant immunochemotherapy including OK-432 (Picibanil) on survival was assessed in patients who underwent curative resection of gastric cancer. Patients enrolled in this randomized controlled study were randomly assigned to group A or group B. Group A patients received 800 mg/d 5'-DFUR (Furtulon) for 2 years from 2 weeks after the operation. Group B patients received OK-432 plus 5'-DFUR by the same regimen as in group A. This study enrolled 288 patients, and 1 patient with malignant lymphoma was excluded. Among the remaining 287 patients, 143 and 144 were allocated to group A and group B, respectively, and their data were included in statistical analysis. The 5-year survival rates for groups A and B were 62.9% and 63.8%, respectively, showing no significant difference (P = 0.7996).     

Induction of tumor necrosis factor by administration of OK-432 in cancer patients

We examined whether OK-432, a streptococcal preparation, could induce tumor necrosis factor in cancer patients. OK-432 was administered at a dose of 100 KE intratumorally to 4 advanced gastric cancer patients and 10KE intracavitary to 8 patients with malignant pleuroperitoneal effusion. The cytostatic activity of the sera and malignant effusions was assayed by the growth inhibition of L929 cells. OK-432 induced significant cytostatic activity in the sera and malignant effusions. The activity was partially neutralized by the monoclonal antibody against human recombinant tumor necrosis factor. These data suggest that OK-432 induces tumor necrosis factor in the sera and malignant effusions of cancer patients.     

A case of Gorham's disease with chylothorax treated curatively with radiation therapy

Gorham's disease, also known as vanishing bone disease or massive osteolysis, is a rare disorder of uncertain etiology. It is characterized by uncontrolled proliferation of vascular or lymphatic capillaries within bone, leading to resorption and replacement with angiomatous tissue. It can be complicated by chylous pericardial and pleural effusions, which can be life threatening. Patients are also at risk of mortality or serious morbidity due to bone destruction, especially when the disease involves the spine. We report the case of a 31-year-old female with Gorham's disease involving several bones along with chylous pericardial and pleural effusions. She was effectively treated with definitive radiation therapy.     

巨大瘢痕疙瘩行三联疗法治疗成功一例:随访12个月

目的 观察手术切除联合复方倍他米松注射液及术后放疗对超大型瘢痕疙瘩的疗效.方法 患者入院后行瘢痕畸形矫正术及美容缝合术,术后即刻注射复方倍他米松磷酸钠1ml,配比2％利多卡因2ml,患处消毒后从瘢痕边缘以近乎与周围皮肤表面平行的方向进针,将药物均匀、缓慢注射于皮损内直至肿胀发白.术后第二天予以电子线放疗,总共放疗5天,...     

The endoscopic intratumor administration of OK-432 in gastric cancer unsuitable for surgery

In eleven patients with gastric cancer who could not be operated on because of advanced age, refusal of surgery, or the presence of complications, the streptococcal preparation OK-432 was administered, both intradermally and by direct injection into the tumor under endoscopic guidance. Via gastric x-ray and endoscopic examinations, the tumor was observed to disappear in two cases-one advanced cancer and one early gastric cancer endoscopically. Particularly in the latter case repeated biopsies revealed no evidence of cancer cells. All patients developed fever after intratumor injection, but in no case was it necessary to discontinue administration, and no other serious side effects were noted. The endoscopic injection of OK-432 appears to be a safe and useful form of therapy for gastric cancer unsuitable for surgery.     

沙培林联合卡铂治疗恶性胸水的临床观察

目的：探讨沙培林联合卡铂治疗恶性胸腔积液的临床疗效。方法：将50例恶性胸水患者随机分为治疗组和对照组，治疗组27例患者采用沙培林联合卡铂胸腔内灌注，对照组23例患者单纯用卡铂治疗，观察两组治疗前后的胸水变化和副作用。结果：治疗组和对照组控制胸水的有效率分别为89％和65％，P〈0．05。治疗组副作用为发热、胸痛、骨髓抑制和消化道反应，但与对照组比较无显著性差异，P〉0．05。结论：沙培林联合卡铂胸腔内注射能有效治疗恶性胸水，且简单易行，较单药卡铂疗效好。     

The effect of dendritic cells activated by OK-432 and pulsed with antigens on cytokine induced killers.

AIM: To study the effect of OK-432 on the maturation and function of human peripheral blood monocyte-derived dendritic cells, and the effect of these dendritic cells on the proliferation and anti-tumor function of cytokine induced killers. METHODS: Through the analysis of DCs' surface molecules, the detection of the proliferation and anti-tumor function of CIKs activated by DCs, we researched the influence of OK-432 on DCs and CIKs. RESULTS: OK-432 have the potential of promoting DCs to express CD1a, CD80, CD83, HLA-DR highly, which is stronger than LPS; DCs activated by OK-432 can facilitate the proliferation and function of CIKs. CONCLUSION: OK-432 can induce DCs' maturation and can thus promote CIKs' functions.     

Interleukin-1 inducing activity of a streptococcal preparation OK-432 and its fractions by human monocytes

Interleukin-1 (IL-1) inducing activity of a streptococcal preparation OK-432 and its fractions by monocytes were investigated in patients with lung cancer and healthy subjects. The results showed that cell free extracts and cell wall fractions of OK-432 were the strong IL-1 inducing fractions. IL-1 activity released by OK-432-stimulated monocytes of patients with lung cancer fell within normal range. OK-432 stimulated intracellular IL-1 synthesis as well as extracellular release by monocytes. These results, therefore, suggested that OK-432 immunotherapy in patients with malignant diseases might be effective by increasing IL-1 production of monocytes.     

A successful trial of enzyme replacement therapy in a case of argininemia

A 5-year-old boy with severe mental retardation and spastic quadriplegia accompanied by tonic seizures and hyperammonemia was diagnosed as having argininemia due to an arginase deficiency in his erythrocytes. His motor and mental abilities began to deteriorate at the age of 3 years. Thereafter, he lost his ability to stand alone, to sit and even to crawl by himself. After he was diagnosed as argininemia , a protein restricted diet was given as therapy, which was accompanied with a supplement of essential amino acids. However, his clinical condition had not improved very much. The erythrocytes in a normal person was found to have the ability to decrease the patient's elevated plasma arginine level to normal when they are mixed in vitro. First we tried replacing his red cells by a blood transfusion. Then we replaced them with the aid of an IBM 2997 blood cell separator. Following this his clinical and biochemical condition improved, and as a result so did his sitting and crawling abilities. It appears that the replacement of red blood cells improves not only the clinical and biochemical conditions, but the general condition of the patient as well.     

A case of isolated congenital ductus arteriosus aneurysm detected by fetal echocardiography at 38 weeks of gestation

A 30 year-old pregnant woman (G1P0) was diagnosed with fetal ductus arteriosus aneurysm (DAA) at 38 weeks of gestation. The three-vessel view of the heart and the sagittal view of the ductal arch showed a 12-mm fusiform dilatation of the ductus arteriosus. Turbulent flow was detected in it by color Doppler. DAA was confirmed by postnatal echocardiography within 24 hours after birth and it spontaneously closed in the neonatal period. Congenital DAA, usually developed in the third trimester, is potentially fatal due to the possible complications such as spontaneous rupture, dissection, and thromboembolism.