Radiation therapy of intracranial germ cell tumors with radiosensitivity assessment.

Fifty patients with pineal and/or suprasellar tumors were treated in the Department of Radiology, University of Tokyo, from 1975 to 1988. Histological diagnosis was obtained in 28 cases, whereas 22 patients were irradiated without pathological verification. Of the 28 patients with histological diagnosis, 11 had germinomas, 13 non-germinoma germ cell tumors, including nine teratomas, two choriocarcinomas and two embryonal carcinomas, two pineocytomas and two pineoblastomas. The treatment protocol since 1981 has been that, after 20 Gy is given with a local irradiation field, if tumor regression is marked and germinoma is highly suspected, whole brain or whole CNS irradiation is performed subsequently; otherwise, surgical intervention is performed followed by systemic chemotherapy plus radiation therapy. The five-year survival rates of histologically proven germinomas, histologically proven non-germinoma germ cell tumors, and clinically suspected germinomas by means of the above-mentioned method as well as tumor marker status were 73%, 28%, and 83%, respectively. The overall five-year survival rate was 61.3%. A statistically significant difference was found between the survival rates for the 11 cases with histologically proven germinoma and the 13 cases with non-germinoma germ cell tumors, although there was no significant difference between the survival rates for the histologically proven germinomas and the clinically suspected germinomas. Therefore radiation therapy is an effective treatment method for the management of intracranial germ cell tumors.     

The immunosuppressive effect of FK 506 on canine lung transplantation.

The immunosuppressive potency of FK 506 was studied after left lung transplantation in adult mongrel dogs in comparison with cyclosporine. Fiberoptic bronchoscopy, bronchial mucosal blood flow measurement with laser Doppler velocimetry, and chest x-ray and pathologic examinations were performed. Group A had no immunosuppression (n = 5); group B received FK 506 (0.10 mg/kg/day intramuscularly (n = 5); group C received cyclosporine (20 mg/kg/day orally) (n = 5). In group A four dogs died of rejection on the seventh to the twenty-first postoperative days. Another one was killed on the fourteenth postoperative day because bronchial dehiscence occurred at the anastomosis. In group B one died of alveolar rejection on the seventh postoperative day. The remaining four survived 28 days and were put to death. In group C all five dogs survived 28 days and were put to death. In group A bronchial stenosis or dehiscence at the anastomosis was found in every one during the early postoperative period. In group B stenosis did not develop in any of the dogs, including the one that died on the seventh postoperative day. In group C slight stenosis was seen in one dog, severe narrowing in another, and good healing in the remaining three. The transplanted lungs were almost normal histologically in four animals of group B, and one showed alveolar phase rejection. In all animals of group A severe rejection was observed, and in group C two of five animals showed vascular phase rejection, two latent phase, and one fibrosis. Histologic examination of the bronchial anastomosis in group B showed almost normal bronchial epithelium and slight submucosal infiltration of mononuclear cells. In group A there was desquamation of epithelium and mild to moderate mononuclear cell infiltration. In group C hyperplasia of the epithelium was observed in two animals, an abscess at the site of anastomosis in one, and mild to moderate mononuclear cell infiltration in all five. With use of laser Doppler velocimetry, bronchial blood flow in group B was found to be the same as in group C. Laser Doppler velocimetry values reached preoperative levels by the twenty-eighth postoperative day in both groups. Although diarrhea developed in two dogs of group B, no other significant side effect of FK 506 was seen.     

A workshop on the high risk group and the preventive oncology of renal cell carcinoma]

A workshop on the high risk group and the preventive oncology of renal cell carcinoma was held in Kyoto on September 7, 1990. The following subjects were presented: 1. Cohort study of renal cell carcinoma (Dr. Hirayama). 2. Pathoepidemiological study on the background of occurrence of renal cell carcinoma (Dr. Aoki). 3. Case-control study on renal cell carcinoma (Dr. Watanabe). 4. Geographic distribution of renal cell carcinoma in Japan (Dr. Minowa). 5. Pathological findings of small renal cell carcinoma (Prof. Yatani). 6. Pathoepidemiological study on occurrence of renal cell carcinoma (Dr. Tsuchihashi). 7. Clinical evaluation of small renal cell carcinoma (Dr. Masuda). 8. Clinical (biological) characteristics of renal cell carcinoma (Dr. Satomi). 9. Mass screening program for renal cell carcinoma on private urological clinic (Dr. Mishina). 10. Early stage detection of renal cell carcinoma (Dr. Ohe). 11. A review on the literature of epidemiology for renal cell carcinoma (Dr. Nakagawa). Possible risk factors reported for renal cell carcinoma were as follows: 1) Work in petroleum-related and dry-cleaning industries were positive risk. A predominant lifetime occupation as a professional was negative risk. 2) Milk or coffee consumption and use of artificial sweeteners were positive. Drinking of alcohol was negative. 3) Obesity was positive. 4) Personal history of cancer was positive. 5) Cigarette smoking was positive. 6) Exposure to radiation or hydrocarbon was positive. 7) Use of estrogen, diuretic and pain relievers was positive. 8) History of myocardial infarction, hypertension and diabetes mellitus was positive.     

FK419, a novel nonpeptide GPIIb/IIIa antagonist, restores microvascular patency and improves outcome in the guinea-pig middle cerebral artery thrombotic occlusion model: comparison with tirofiban.

The antithrombotic efficacy of FK419, a novel nonpeptide platelet glycoprotein IIb/IIIa antagonist, was compared with tirofiban in guinea-pigs. FK419 and tirofiban similarly inhibited platelet aggregation in vitro (IC50 values: 0.43+/-0.076 and 0.41+/-0.053 micromol/L) and dispersed aggregated platelets (EC50 values: 2.3+/-0.88 and 2.0+/-0.81 micromol/L). FK419 inhibited retention of platelets and neutrophils in a collagen-coated bead column with greater potency than tirofiban (IC50 values of 0.90+/-0.133 and 2.4+/-0.21 micromol/L for platelet retention and 0.32+/-0.078 and 0.57+/-0.180 micromol/L for neutrophil retention). When FK419 or tirofiban were administered after photochemically induced middle cerebral artery (MCA) occlusion in guinea-pigs, they dose-dependently improved MCA patency. FK419 reduced neurological deficits and ischemic brain damage in a dose-dependent fashion, whereas tirofiban did not. Reduced regional cerebral blood flow in the striatum gradually returned to the preoccluded level with FK419 treatment; however, no restoration was observed with tirofiban even though the MCA was recanalized. These results indicate that FK419 ameliorates ischemic brain damage by not only lysing the obstructive thrombus in MCA but also preventing or restoring microcirculation deficits after occlusion/reperfusion, suggesting that FK419 would be an attractive intervention for the treatment of ischemic stroke patients.     

Respiration-related movements of the nose in dogs

We studied the respiration-related movements of the canine nose by examining the respiratory oscillations of intranasal balloon pressure and EMG activities of the dilator nares in dogs. Under spontaneous respiration, balloon pressure decreased and EMG activities increased during the early inspiratory phase. These respiratory movements of the nose differed and changed reciprocally in strength between the two sides of the body spontaneously, after painful stimulation or intranasal histamine administration. When the muscle relaxant was administered and the respiration was controlled by the ventilation pump, the intranasal balloon pressure increased during the inspiratory phase. This phenomenon had a completely inverted pattern compared with that during spontaneous respiration. Furthermore, even when the ventilation pump was stopped, respiration-like spontaneous oscillations of the intranasal balloon pressure were recognized. These were abolished by sectioning of the ipsilateral cervical sympathetic nerve trunk. From these findings, the respiration-related movements of the nose were thought to be controlled not only by the cardiac output and the vagal nerve reflexes but also by respiratory activities in the nervous systems controlling the nose, which might be originated from the medullary respiratory centres.     

Surgical treatment of small cell lung cancer

Thirty four small cell lung cancer (SCLC) patients underwent operation in Kyoto University from 1976. The mean age was 62 years old; 25 male cases, 9 female, respectively. All case were limited disease (LD) except 2 patients with rib metastasis. Seventeen patients had a performance status (PS) of 0 and 17 PS 1, twenty eight patients were treated with chemotherapy. Of the remaining 5 patients, 2 were treated by only oral 5-FU derivatives, one died within 30 days of operation, one could not be treated owing to old-age, and one refused chemotherapy. Except one operational death 33 cases were able to be evaluated. Out of 28 patients, 16 patients were treated by only postoperative chemotherapy. Concerning operational radicality, 21 cases out of 31 were operated radically (68%). The survival rates of these 33 patients were 78% 37% at 1, 3 and 5 years respectively. The MST was 26 months. The neoadjuvant group head better results than the non-adjuvant group.     

Clinical results of total knee arthroplasty using Kinematic type in patients with rheumatoid arthritis under the age of 50 years

We reviewed 24 total knee arthroplasties using Kinematic type (anteriorly joined type or posterior cruciate retention type) in 18 rheumatoid patients who were under the age of 50 years. Thirteen knees with Kinematic type total knee arthroplasty in 10 rheumatoid patients who were over 70 years of age were also reviewed. Using rheumatoid arthritic knee rating score of J.O.A. (Japan Orthopedic Association), the clinical results of young patients were evaluated and were compared with those of elderly patients. The average total score of young patients and that of older patients was almost equally increased after arthroplasty. Postoperatively in older patients, pain score was elevated more remarkably than in young patients. However, increase in score of quadriceps muscle strength, walking ability and climbing stairs ability were less in older patients than that in young patients. Range of motion was not improved in both young and older patients. However, flexion contracture was improved remarkably in both groups.     

Problems with topical therapies for extensive squamous cell carcinoma of the buttocks]

In patients in whom cancer originating from a bed-sore has advanced to a stage where radical treatment is impossible, topical treatment with ointment, or systemic anti-cancer chemotherapy, is usually applied. We recently attempted treatment of extensive squamous cell carcinoma of the buttocks, for which radical treatment was impossible, by chemotherapy using a reservoir for intraarterial injection. This therapy involved intraarterial injection of bleomycin and 5-FU, together with topical treatment with 5-FU ointment. We describe the problems encountered with this therapy, e.g., measures against fever after intraarterial injection, management of the affected area, evacuation, possibility and limits of radiation therapy, and assessment of its efficacy.