Radiotherapy concurrent with S-1 and radiotherapy alone for T2N0 glottic carcinoma: A retrospective comparative study

Objective

We examined the completion rate, safety, and adverse events in patients with T2N0 glottic carcinoma who received chemoradiotherapy with S-1 (tegafur–gimeracil–oteracil potassium).

Methods

In T2N0 glottic carcinoma patients, we retrospectively compared the local control rate and outpatient therapy completion rate between 20 patients who received radiotherapy plus S-1 (S-1 group) and 20 who received radiotherapy alone (RT group).

Results

Local recurrence was not detected in any of the 20 subjects from the S-1 group, whereas local recurrence was found in 4 of the 20 subjects (20%) from the RT group (p < 0.05). Outpatient treatment was completed by 15 of the 20 subjects from the S-1 group and 17 of the 20 subjects from the RT group (p = 0.43).

Conclusion

We investigated chemoradiotherapy with S-1 in patients who had T2N0 glottic carcinoma and found a higher local control rate when compared with radiotherapy alone as well as comparable safety for outpatient delivery.     

Immunohistochemical demonstration of increased glucose-6-phosphate dehydrogenase in preneoplastic and neoplastic lesions induced by propylnitrosamines in F344 rats and Syrian hamsters

Changes in the level of expression of glucose-6-phosphate dehydrogenase (G6PD) within propyl nitrosamine-induced preneoplastic and neoplastic lesions in F344 rats and Syrian golden hamsters were investigated using an immunohistochemical approach. Previously demonstrated increases in G6PD activity in rat liver and hamster pancreatic foci of altered cells were revealed as being due to elevation in the quantity of enzyme protein, suggesting an underlying change in gene expression. Furthermore, strong positive binding of G6PD antibody in thyroid, lung, urinary bladder and kidney lesions indicated that increase in this enzyme protein might be a common marker for neoplastic alteration, regardless of organ. While the function of elevated G6PD may be related to growth requirements, the finding that preneoplastic lesions in some cases bind more strongly than more malignant populations suggests additional involvement of the enzyme in other biochemical pathway(s) relevant to tumorigenesis.     

Stevens-Johnson syndrome accompanied by acute hepatitis in workers exposed to trichloroethylene or tetrachloroethylene]

Since the late 1980s, there has been an increasing tendency in the number of case reports on Stevens-Johnson syndrome accompanied by acute hepatitis in workers exposed to trichloroethylene from Asian countries. Recently, mass outbreaks of it have been disclosed in the Philippines and China. Besides trichloroethylene, although the number is small, a similar health disorder has also occurred in workers using tetrachloroethylene. Since the above-mentioned facts are not yet well recognized in the occupational health community, this review is aimed at making clear (1) the clinical features of the health disorder, (2) details of patients' jobs, working environments, and exposure to hazardous chemicals, and (3) the relationship between exposure to trichloroethylene or tetrachloroethylene and the health disorder. Based on a critical review of articles, the following were pointed out. First, it is important to carefully observe the health status of workers exposed to trichloroethylene or tetrachloroethylene and to take countermeasures to reduce exposure. Secondly, circumstantial evidence suggests a cause-effect relationship between the two chemicals and the health disorder; but at the present time it is impossible to rule out the participation of unelucidated factors promoting the occurrence of the health disorder or the existence of a hidden genuine causative substance. Therefore further investigation to trace such a case is needed. Thirdly, the mechanism of the health disorder and the reason why there seems to be a large inter-individual difference in sensitivity to the causative agent should be clarified.     

Noradrenaline release in rat locus coeruleus is regulated by both opioid and alpha(2) -adrenoceptors.

Extracellular fluid levels of noradrenaline (NA) in the locus coeruleus (LC) during naloxone-precipitated morphine withdrawal with pretreatment of yohimbine (1 mg kg (-1), s.c.) or clonidine (1 mg kg (-1), s.c.) were measured in rats. There was a significant increase in the NA level after the injection of naloxone (2 mg kg (-1), i.p.) in the morphine-dependent rats. Moreover, the NA levels in the LC markedly increased during the 30-60 min following the naloxone (i.p.) challenge in the morphine-dependent rats pretreated with yohimbine. In contrast, the naloxone challenge in morphine-dependent rats pretreated with clonidine notably decreased the levels of NA in the LC. Behavioral signs of withdrawal were observed following the naloxone challenge in the morphine-dependent rats pretreated with yohimbine, with minimal signs in the morphine-infused rats pretreated with clonidine, and none in the saline-infused controls. These results directly suggest that NA increased within the LC after the naloxone challenge in morphine-dependent animals pretreated with yohimbine may be, at least in part, regulated by alpha(2) -adrenoceptors in the LC.     

An iterative method for improved estimation of the mean of peer-group distributions in proficiency testing.

In proficiency testing (PT), the peer-group mean is conventionally computed after twice removing values exceeding the mean +/- 3 SD. However, this adjustment fails if there are many outliers. In this study an iterative method was evaluated as a more robust way to estimate the means. The methodology repeatedly removes a proportion of the population (usually those exceeding the mean +/- 1.6 SD), assuming the presence of a Gaussian distribution in the central portion, and reinflates the SD to compensate for the trimming. A computer simulation revealed that the estimated mean of a known Gaussian distribution was less affected by a subpopulation that overlaps the main population than was the conventional method. When the overlapping portions were removed, the iterative method predicted the true mean correctly. The method was applied to external PT results for 44 analytes. Although most peer-group distributions were clearly non-Gaussian, the segment included by the predicted mean +/- 1.6 SD was regarded as Gaussian in 85.9% by the new method and 73.4% by the conventional method. The proposed methodology appears to be an improved way of estimating peer-group means.     

Attenuation of Ischaemia-Induced Regional Myocardial Acidosis by Bevantolol,a β1-Adrenoceptor Antagonist,in Dogs

Abstract: In dogs anaesthetized with pentobarbital, the left anterior descending coronary artery (LAD) was occluded for 90 min. so that about 1/2 of the original flow was allowed to flow (partial occlusion). Bevantolol (a β₁-adrenoceptor antagonist) or propranolol (a reference drug) was injected intravenously 30 min. after partial occlusion. Regional myocardial pH was measured by a micro glass pH electrode inserted in the LAD area. Partial occlusion decreased myocardial pH by 0.62 to 0.74. Bevantolol (1.0 mg/kg) or propranolol (1.0 mg/kg) significantly increased myocardial pH, that had been decreased by partial occlusion, within 60 min. after the injection. Restoration of myocardial [H⁺] (defined as return towards a lower [H⁺] to the preocclusion level) (calculated from the pH data) induced by bevantolol and that induced by propranolol were 64.0 and 66.4% (measured 60 min. after the injection), respectively. Bevantolol or propranolol decreased heart rate also. Even in the paced heart, bevantolol restored the myocardial [H⁺] that had been increased by partial occlusion. These results suggest that bevantolol has a favorable effect on the ischaemic myocardium as has propranolol, and that the pH effect of bevantolol is not primarily due to a decrease in heart rate.     

Immunohistochemically demonstrated suppressed expression of tryptophan oxygenase, a marker for liver differentiation, within putative preneoplastic rat liver lesions

The behaviour of rat liver putative preneoplastic lesions withrespect to the enzyme tryptophan oxygenase (TO), a liver-specificdifferentiation marker, and a possible growth-related marker,glucose-6-phosphate dehydrogenase (G6PD) was investigated duringand after their induction by diethylnitros-amine initiationand subsequent ‘selection pressure’. Using specificantibodies to rat liver TO and G6PD and the avidin-biotin complexmethod for immunohistochemical staining it was demonstratedthat all of the nodular lesions showing increased expressionof G6PD during the induction phase were also negative or deficientin TO enzyme protein. With the onset of ‘phenotypic instability’or loss of marker enzymes, a gradual return to normal expressionof TO activity was evident. Administration of dexamethasoneand L-tryptophan 11 weeks after cessation of carcinogen treatmentallowed differentiation between morphologically altered, apparentlypersisting lesions in which no, or little, enzyme inductionwas apparent and instable lesions showing a strong increasein levels of TO protein. Thus, persisting nodular lesions sharea common lack of response to normal homeostatic physiologicalcontrol.     

Long term results of transsphenoidal adenomectomy in patients with Cushing's disease

As part of an ongoing series, 100 patients with Cushing's disease underwent transsphenoidal operations. Pituitary adenomas were confirmed in 93 patients, and initial remission was achieved in 86 (92%) of them. Hypercortisolemia was not corrected in 7 patients, and in 4 this was due to invasive adenomas. These patients were subjected to irradiation, medical treatment, or both after operation. Only 7 of the 100 patients had no pituitary adenoma found at operation, and they obtained no clinical remission even after partial or subtotal hypophysectomy. Follow-up review, with an emphasis on endocrinological studies, was performed on these patients for a mean period of 38 months. Seventy-eight patients were in long term remission after operation and had restoration of noncorticotropic hormone secretion as well as pituitary-adrenal function. Recurrence was noted in 8 patients after 19 to 82 months in remission. In all of these patients, pituitary adenomas were verified by reoperation and no case of corticotrophic cell hyperplasia was noted. We conclude that late recurrence of Cushing's disease may occur after adenoma removal and is due to the regrowth of adenoma cells left behind in the peritumoral tissue at the first operation. In view of the overall remission rate, transsphenoidal adenomectomy is considered a highly effective treatment for Cushing's disease.     

A possible involvement of oxygen free radicals in the development of myocardial acidosis during coronary occlusion in dogs

Summary The present study was designed to examine whether free radical scavengers attenuate myocardial acidosis induced by partial occlusion of the coronary artery in dogs. The myocardial pH was determined by a micro glass pH electrode inserted in the endocardial layers of the left ventricular wall perfused by the left anterior descending coronary artery. The left anterior'descending coronary artery was occluded for 90 min incompletely so that the flow would be 1/2–1/3 the original flow. The myocardial pH before partial occlusion was 7.54–7.55. Partial occlusion decreased the flow in the left anterior descending coronary artery by 49.3–64.9% and the myocardial pH by 0.71–0.76, and increased the ST segment (surface electrocardiogram) by 6.3–9.3 mV. Saline (0.5 ml/kg), recombinant human superoxide dismutase (70,000 or 210,000 U/kg), or catalase (55,000 or 165,000 U/kg) was injected intravenously 30 min after partial occlusion. The injection of recombinant human superoxide dismutase or catalase alone did not restore the myocardial pH that had been decreased by coronary occlusion. The combined injection of recombinant human superoxide dismutase (70,000 U/kg) + catalase (55,000 U/kg), however, restored the myocardial pH without restoration of ST segment. In conclusion, recombinant human superoxide dismutase + catalase attenuated myocardial acidosis during ischaemia, suggesting a possible involvement of oxygen free radicals in the development of myocardial acidosis (especially in the endocardial layers) during ischaemia. Send offprint requests to Y. Abiko at the above adress     

A treatment of intractable sternal osteomyelitis--significant use of pedicle muscular flaps

In recent years, the greater omentum of pedicle muscular flap has been used to treat chest wall infection and Sternal Osteomyelitis following cardiac or respiratory surgery. In Japan, however, there has been an increasing number of cases in which neither the greater omentum Nor the rectus muscle can be used due to the comparatively young age of the patient. There are also many cases undergoing abdominal surgery for malignant tumor and bypass surgery of the coronary artery in which the internal thoracic artery (ITA) and gastroepiploic artery (GEA) are used. We studied three such cases; a case of coronary aortic bypass graft (CABG) where ITA from both the right and left sides were used following stomach resection; a case in which CABG and gallbladder resection were carried out simultaneously; and a case of sternal osteomyelitis is years following surgery for ventricular septal defect. All three cases had undergone reconstructive surgery using the pectoralis major muscle or a pedicle muscular flap from the latissimus dorsi muscle. It is estimated that cases of CABG using both the right and left sides of ITA and GEA, cases of the elderly as well as cases of children will continue to increase. Consequently, cases of sternal osteomyelitis in which neither the omentum nor rectus muscle can be used will also increase. Therefore, it is considered that treatment using pedicle muscular flaps from the breast or dorsal area may be very effective. Herein, we report on the choice of treatment and its results.