Thawing of frozen shoulder in menopausal women treated with a Japanese herbal medicine, Kanzo-to extract: report of two cases

We report here two patients with frozen shoulder syndrome and severe menopausal symptoms. Short-term administration of Kanzo-to extract thawed the shoulders completely enough for the patients to move their cervical and shoulder joints without any restriction or pain. Their menopausal symptoms were cured simultaneously. Kanzo and Shakuyaku were found to have different effects on shoulder stiffness and disability in shoulder joints.     

Anti-endometrial IgM autoantibodies in endometriotic patients: a preliminary study

Japanese herbal medicines (Kampo medicines) are usually the third most popular choice among medicines for treatment of endometriosis in Japan. This traditional therapy is used to improve various signs and symptoms of endometriosis without decreasing serum estradiol levels or causing menstrual disorders. We used flow cytometry to examine and compare the effects of the Kampo therapy and danazol on anti-endometrial humoral immunity. Autoantibodies against endometrial epithelial cell lines and endometrial stromal cells were detectable in all the examined sera of men and women irrespective of the presence of endometriosis. Moreover, no significant increase in anti-endometrial antibodies was found in endometriotic patients. Anti-endometrial antibodies included Ig-gamma chain, Ig-mu chain, Ig-kappa chain, and Ig-lambda chain indicating polyclonal B cell activation in the endometriotic patients. Absorption tests of nonspecific antibodies with cervical cancer cells or ovarian cancer cells revealed that endometriotic patients had higher levels of endometrium-specific autoantibodies than did non-endometriotic healthy women. IgM fractions from endometriotic patients and healthy women differed in their effect on growth of endometrial adenocarcinoma cells. Therapy with the herbal compounds Keishi-bukuryo-gan but not danazol therapy, gradually decreased the tissue-specific anti-endometrial IgM antibody levels. These results indicate that tissue-specific anti-endometrial IgM may be a useful therapeutic marker for endometriotic patients treated with Keishi-bukuryo-gan and that endometrial tissue-specific immune disorders play specific roles in the pathogenesis or development of endometriosis.     

Remarkable suppressive effect of consecutive low-dose cisplatin therapy on advanced ovarian clear cell adenocarcinoma.

Ovarian clear cell adenocarcinoma (OCCA) is known to be less responsive to cisplatin and most other anti-cancer drugs and to have a poorer prognosis than other ovarian cancers. We report a rare case of stage IIIc OCCA in a patient who has been treated postoperatively with cisplatin alone and continues to survive after 7.5 years. In this case, 25 mg/m2/day of cisplatin was administered for 5 consecutive days every 4 weeks. After remission, intermittent administration of cisplatin every 3 to 4 months was performed 8 times. This case suggests that induction and intermittent chemotherapy using consecutive low-dose cisplatin administration may be a useful treatment for OCCA.     

Anti-inflammatory activity of probiotic Bifidobacterium： Enhancement of IL-10 production in peripheral blood mononuclear cells from ulcerative colitis patients and inhibition of IL-8 secretion in HT-29 cells

AIM： To determine the anti-inflammatory activity of probiotic Bifidobacteria in Bifidobacteria-fermented milk （BFM） which is effective against active ulcerative colitis （UC） and exacerbations of UC, and to explore the immunoregulatory mechanisms. METHODS： Peripheral blood mononuclear cells （PBMNC） from UC patients or HT-29 cells were co-cultured with heat-killed probiotic bacteria or culture supernatant of Bifidobacterium breve strain Yakult （BbrY） or Bifidobacterium bifidum strain Yakult （BbiY） to estimate the amount of IL-10 or IL-8 secreted. RESULTS： Both strains of probiotic Bifidobacteria contained in the BFM induced IL-10 production in PBMNC from UC patients, though BbrY was more effective than BbiY. Conditioned medium （CM） and DNA of both strains inhibited IL-8 secretion in HT-29 cells stimulated with TNF-α, whereas no such effect was observed with heat- killed bacteria. The inhibitory effect of CM derived from BbiY was greater than that of CM derived from BbrY. DNAs of the two strains had a comparable inhibitory activity against the secretion of IL-8. CM of BbiY induced a repression of IL-8 gene expression with a higher expression of IκB-ζ mRNA 4 h after culture of HT-29 cells compared to that in the absence of CM.CONCLUSION： Probiotic Bifidobacterium strains in BFM enhance IL-10 production in PBMNC and inhibit IL-8 secretion in intestinal epithelial cells, suggesting that BFM has anti-inflammatory effects against ulcerative colitis.     

Management of vulvar cancer]

In the treatment of vulvar malignancy surgery, chemotherapy, irradiation therapy and so on can be used. Actually, it was rarely performed only by a single method. For treatment by the stage of cancer progression, the superficial cancer was treated by wide local resection for the patients except old women who were done simple vulvectomy. For the invasive cancer, stage 1 or 2, the pre-operative bleomycin (BLM) was administered to reduce the tumor mass, thereafter, radical vulvectomy with inguinal lymph node resection was performed. If inguinal lymph nodes metastasis was found, area of resection was extended to pelvic lymph nodes. Recently, micro-invasive carcinoma was defined that the foci was below 2 cm and interstitial invasion below 1 mm. In this condition, it was needless to remove the lymph nodes. For the stage of 3 or 4 which was inoperable, chemotherapy (mainly BLM) combined with irradiation therapy was done. In the cases of good general condition, it was chosen by super-radical vulvectomy.     

Clinicopathologic differences of mesenchymal submucosal tumors between the esophagogastric junction and the upper stomach

Objective

We compared the clinicopathologic features between mesenchymal tumors located in the esophagogastric junction (EGJ) and upper stomach, that had been removed surgically.

Methods

Thirty-five patients with a submucosal tumor (SMT) of the stomach, including the EGJ, were surgically treated over the last decade. Of these, 23 patients with SMTs located in the upper third of the stomach (n = 15; UG-group) and EGJ (n = 8; EGJ-group) were studied.

Results

The mean age was younger in the EGJ-group than in the UG-group, and the EGJ-group frequently showed symptoms. Histopathologically, 4 gastrointestinal stromal tumors (GISTs) and 4 leiomyomas were observed in the EGJ-group, while 14 GISTs and one schwannoma were observed in the UG-group (p = 0.0096). Two tumors macroscopically showed a horseshoe or spiral type in the EGJ-group, while all tumors showed a ball/ball-like appearance in the UG-group. Regarding surgical procedures, 7 patients underwent laparotomy in the EGJ-group, while 9 patients underwent laparoscopic surgery in the UG-group. The mean operating time was longer and operative bleeding was greater in the EGJ-group than in the UG-group, respectively (p = 0.0015 and p = 0.0095). Postoperative complications were frequently observed in the EGJ-group. The EGJ-group showed no patients with recurrence and/or metastasis after surgery, while three cases with GISTs had them in the UG-group. In GISTs, the mean mitotic index of the UG-group was relatively more than that of the EGJ-group and a case was classified into the high-risk group, although there was no significance in the risk classification between the two groups.

Conclusion

SMTs included GISTs and leiomyomas in the EGJ, while the majority demonstrated GISTs in the upper stomach. SMTs of the EGJ were removed by a tailored approach to prevent recurrence as well as postoperative complications. The biological behavior of GISTs may be different between the EJG and stomach.     

Effect of fetal thymic extract on maturation of precursor lymphocytes from cancer patients with various stages.

Thymus humoral factor seems to have an ability of differentiating the precursor T cells (PTC) into cells bearing T-cell (thymus-dependent lymphocyte) characteristics. Human fetal thymic extract (hFTE) was examined for in vitro effect on the concanavalin A (Con A) responsiveness of peripheral blood lymphocytes in 28 patients with uterine cervical cancer and 9 healthy volunteers. The result was expressed as percentage increase of Con A response of the hFTE-treated group to that of the nontreated group. The effect of hFTE was found to be pronounced in patients in Stages 0 and I, in spite of the small difference in T-cell count in unit volume of peripheral blood. Meanwhile, the effect of hFTE was no longer observed in patients with advanced cancer (Stages III and IV). The present study has suggested that some of PTC, which are prevented from differentiating into mature T cells in vivo due to presumably depressed thymic hormone production, accumulates in peripheral blood of patients with early cancer. And it was also suggested that decrease of both PTC and T-cell count in patients with advanced cancer is due to general immunodeficiency.