Reduction of End-stage Malignant Glioma by Injection with Autologous Cytotoxic T Lymphocytes

Autologous cytotoxic T lymphocytes (CTL) against primary-cultured malignant gliomas were generated from peripheral blood mononuclear cells in vitro in 4 patients. Activities of the CTL were highly specific to the corresponding autologous glioma and were inhibited, in one patient, with antibodies against CD3, CD8 and MHC-class I molecules. When the CTL were injected 3 times into the primary-tumor-resected cavity via an Ommaya tube, reduction of the recurrent tumors with magnetic resonance imaging (MRI)-measured volumes exceeding 45 cm³ was observed in 3 patients. In a patient with glioblastoma multiforme (GBM), the tumor volume (estimated, 130 cm³) was rapidly reduced to 1/3, although re-recurrence of the tumor followed 40 days later. A slight but distinct rapid reduction of the tumor volume was observed in another GBM patient and in an anaplastic astrocytoma patient; essentially no change was observed in a further GBM patient. These results suggest that adoptive immunotherapy with autologous CTL will be clinically effective against end-stage malignant gliomas.     

Antitumor Effect on Human Gastric Cancer and Induction of Apoptosis by Vascular Endothelial Growth Factor Neutralizing Antibody

Induction of apoptosis by antiangiogenic therapy has been suggested as a new anticancer strategy. To clarify the mechanism of the antitumor effect achieved by inhibition of vascular endothelial growth factor (VEGF), which is a major mediator of angiogenesis, we used an orthotopic transplantation model of human gastric carcinoma line (MT2) treated with a monoclonal VEGF neutralizing antibody (VEGF Ab). We histologically examined the microvessel density (MVD) and the apoptotic index (AI) in this model. Transplanted tumor growth was significantly inhibited by the VEGF Ab ( P = 0.03), and there was a significant decrease in the number of mice with liver metastasis ( P = 0.004). The MVD detected by immunohistochemical staining with ER-MP12 antibody was 33.6 ± 8.0 in the control group and 21.1 ± 5.4 in the treated group, and the difference was significant ( P < 0.0001). The AI values of the control and treated groups were 4.73 ± 1.11 and 7.26 ± 1.62, respectively, and this difference is also significant ( P < 0.0001). However, the expression of VEGF mRNA in transplanted tumors did not show a significant difference between the control and treated groups. These results suggest that the antitumor effect of the VEGF Ab on human gastric carcinoma is exerted by inducing mild hypoxia followed by apoptosis, which does not influence VEGF mRNA expression in the carcinoma.     

Laparoscopic total gastrectomy with distal pancreatosplenectomy and D2 lymphadenectomy for advanced gastric cancer

Received on Aug. 31, 1999; accepted on Jan. 27, 2000     

冠状动脉内超声检查在冠状动脉斑块旋切术中的应用

将冠状动脉内超声检查（ＩＣＵＳ检查）应用于冠状动脉斑块旋切术（ＤＣＡ）中,３２例冠心病患者手术的获成功。平均冠状动脉内径由术前１．０６ｍｍ增加至术后３．５９ｍｍ,术后残留狭窄均小于２５％,无１例发生冠状动脉穿孔、破裂等严重并发症。在ＤＣＡ中,应用ＩＣＵＳ可提高ＤＣＡ的疗效与成功率,并可降低并发症。     

IgA nephropathy with myeloperoxidase anti-neutrophil cytoplasmic antibodies (MPO ANCA): a discrepancy between the histological activity and MPO ANCA

Anti-neutrophil cytoplasmic antibodies (ANCA) of the immunoglobulin (Ig)G type are associated with rapidly progressive glomerulonephritis. Such antibodies have been detected only rarely in patients with Henoch-Schönlein purpura (HSP) or IgA nephropathy (IgAN). We report a patient with biopsy-proven IgAN with fibrous crescents in whom high titers of IgG ANCA occurred and were confirmed to be anti-myeloperoxidase antibodies (MPO ANCA) by solid-phase enzyme-linked immunosorbent assay (ELISA) and inhibition studies. During a 1-year follow-up period, high titers of MPO ANCA persisted but creatinine clearance remained over 50 ml/min per 1.48 m.² This case suggests the lack of a reliable association between fulminant outcome of IgAN with crescents and high titers of IgG MPO ANCA, and indicates the involvement of subsets of IgG MPO ANCA which recognize important or unimportant epitopes of MPO in the pathogenesis.     

Plasma lipoprotein (a) levels in children with minimal lesion nephrotic syndrome

We studied the plasma lipoprotein (a)[Lp(a)] levels in 31 children with minimal lesion nephrotic syndrome (MLNS) in both stages of acute NS and remission.The mean Lp(a) levels in acute NS were significantly higher than those of the controls. The Lp(a) levels in remission were significantly lower than the Lp(a) levels in acute NS. In addition, the Lp(a) levels in remission were not significantly different from those of the controls. However, there were 5 patients whose Lp(a) levels remained higher than 30 mg/dl (the generally accepted limit for cardiovascular risk) after remission. Two of these 5 patients had Lp(a) levels greater than 40 mg/dl. In these patients apoprotein (a) [apo(a)] phenotypes were of lower molecular weight than those of the other 23 patients whose apo(a) phenotypes were examined. Additional episodes of relapse may put the patient with sustained elevated Lp(a) levels at significant risk for the development of cardiovascular disease in the long term. Received: 17 November 1998 / Revised: 9 March 1999 / Accepted: 16 March 1999     

Awake tracheal intubation through the intubating laryngeal mask

PURPOSE: To report successful awake insertion of the intubating laryngeal mask (Fastrach) and subsequent tracheal intubation through it, in a patient with predicted difficult tracheal intubation, due to limited mouth opening, and difficult ventilation through a facemask, due to a large mass at the corner of the mouth. CLINICAL FEATURES: A 53-yr-old woman with a large post-gangrenous mass on the right cheek to the angle of the mouth was scheduled for its resection. The right side of her face was damaged by a bomb attack followed by cancrum oris 50 yr ago. The distance between the incisors during maximum mouth opening was 2 cm and that between the gums on the right side < 1 cm. After preoxygenation and 50 micrograms fentanyl and 30 mg propofol i.v., propofol was infused at 2 mg.kg-1.hr-1. Lidocaine, 8%, was sprayed on the oropharynx. A #4 intubating laryngeal mask was inserted with a little difficulty. A fibrescope was passed through a 7.5-mm ID RAE tracheal tube, and the combination was easily passed through the laryngeal mask into the trachea. General ansthesia was then induced. Finally, the intubating laryngeal mask was removed, while the RAE tube was being stabilized using an uncuffed 6.0-mm ID tracheal tube. CONCLUSION: Awake tracheal intubation through the intubating laryngeal mask is a useful technique in patients with limited mouth opening in whom ventilation via a facemask is expected to be difficult.     

Klinische Beiträge zur Kenntnis der Röteln. (Beobachtungen über eine Epidemie in Port Arthur im Jahre 1913.)

Zusammenfassung 1. Die Inkubationsdauer der Röteln liegt zwischen 15–23 Tagen.2. Die Temperatursteigerung über 38° kommt bei den Röteln sowohl im Prodromalstadium als auch in der Eruptionszeit nicht selten vor; die Zeitdauer derselben ist nicht länger als 3 Tage, meist geht sie binnen 2 Tagen rasch zurück.3. Das eigentümliche papulöse Exanthem, welches von deutlich anämischem Hof umgeben ist, scheint den Röteln ziemlich charakteristisch.4. Lymphdrüsenschwellung ist ein fast konstantes Symptom der Röteln. Milzschwellung tritt nicht selten auf.5. Diazoreaktion, Indican- und Albuminurie werden vorübergehend bei den Röteln beobachtet.6. Leichte Verminderung des Hämoglobingehaltes des Blutes im Abblassungsstadium, Steigerung der Zahl der neutrophilen Zellen und zugleich eine Verminderung der Leukocyten im Höhestadium des Exanthems werden bei den Röteln konstatiert. Eosinophilie kommt bei den Röteln häufig, meist in den Abblassungszeiten vor. Schwankungen in der Gesamtzahl der Leukocyten sind bei den Röteln nicht gesetzmäßig.7. Eine fast verschwundene Tuberkulin-Cutanreaktion bei vorhandener Tuberkulose kann bei den Röteln im Höhestadium des Exanthems wieder deutlich werden.     

LEIOMYOBLASTOMA OF THE GREATER OMENTUM

A case of leiomyoblastoma of the greater omentum, occurring in a 36-year-old man was described. Leiomyoblastoma of the omentum is extremely rare and only 6 cases have been reported in the Japanese and English literature up to date. According to the review of these cases, including the present case, 1) females were affected more frequently than males, and the age ranged from 36 to 76 years; 2) leiomyoblastoma was usually a large tumor which caused abdominal fullness and pain, and occasionally complicated with anemia and bloody ascites; 3) mitosis was rare, and there was no sign of metastasis and recurrence. Finally the morphological criteria and clinical parameters of malignancy in leiomyoblastoma were discussed. ACTA PATHOL. JPN. 37: 1691-1698, 1987.