Long-term survivors after hepatectomy for hepatocellular carcinoma

Sixteen long-term (more than 5 years) survivors after hepatic resection performed for hepatocellular carcinoma (HCC) from 1970 to 1988, were reviewed. The mean age of the patients was 51 years. There were 11 males and 5 females. HBs antigen was positive in 9 patients. Liver cirrhosis was associated with 11 patients but its severity was designated as Child's A in all patients except one. The mean tumour diameter was 2.8 cm and was relatively small. At the first operation, limited procedures (i.e. partial hepatectomy and subsegmentectomy) were employed in 87.5% of patients. A large percentage of tumours were located in S5 and S6 segments. A recurrence of HCC occurred in 9 patients after the first resection. A second resection was carried out in 7 patients, in 2 of which a third resection was done. Transcatheter arterial embolization (TAE) was performed on 4 patients. These results show that, in addition to detection of small tumours and early resection, repeated operation or TAE for treatment of recurrent HCC was important in achieving long-term survival after HCC resection.     

Transitional cell carcinoma in an ectopic ureter

We experienced an 82-year-old man with transitional cell carcinoma in an ectopic ureter draining into the prostatic urethra. Carcinoma arising from an ectopic ureter is very rare and a differential diagnosis is difficult. To our knowledge, our case is the third male case reported in the literature.     

The Incidence of Cardiac Metastasis in Primary Lung Cancer and the Management of Malignant Pericardial Effusion

The incidence of metastasis to the heart and pericardium was35% in post-mortem studies of 150 cases of carcinoma of thebronchus. Twenty-one patients with malignant pericardial effusion fromcarcinoma of the bronchus were treated at the National CancerCenter Hospital during the last three years. Fifteen patientswere treated by creating a pericardial window through a subxiphoidapproach without complications or mortality, in these 15 patientscardiac compression caused by pericardial effusion was promptlyrelieved by the creation of the pericardial window. There wasno reaccumula tion of the effusion in five of six patients treatedby the pericardial window procedure with intrapericardial instillationof chemotherapeutic agents and eight of nine patients treatedby creating the window without local chemotherapy. On the otherhand cardiac tamponade was controlled in one of three patientsby repeated pericardiocenteses. The median survival periodsfrom the initiation of treatment for the effusion up to deathwere 4 mo in six patients treated by the pericardial windowprocedure with intrapericardial instillation of chemotherapeuticagents, 2 mo in nine patients treated by the window techniquewithout local chemotherapy and 0.8 mo in six patients in whoma pericardial window was not created. The median survival of15 patients treated by the pericardial window procedure (2 nio)was not significantly longer than that of six patients not sotreated. We have come to the conclusion that the creation of a subxiphoidpericardial window is a safe, effective and reliable treatmentprocedure for the manage ment of malignant pericardial effusion,but the prognosis for survival in patients with malignant pericardialeffusion may depend principally on the extent of the primarytumor and the performance status of patients at the initiationof treatment for the effusion.     

Effect of Chaetochromin A, Chaetochromin D and Ustilaginoidin A, Bis (naphtho-γ-pyrone) Derivatives, on the Mouse Embryo Limb Bud and Midbrain Cells in Culture

Abstract Mouse embryo limb bud (LB) and midbrain (MB) cells were prepared from day 10 mouse embryos and cultured as micromass cell islands for 5 days. Differentiation was determined by the number of stainable foci of differentiated cells, and the concentration at which each compound inhibited the formation of differentiated foci by 50% of the control value (IC₅₀) was estimated according to the method by Flint and Orton (1984). The values of IC₅₀ of L-dopa, which is known as a teratogen, were 24 μig/ml in LB cultures and 12 μ/ml in MB cultures, respectively. Teratogenic hazards of three mycotoxins were compared in this system. Chaetochromin A and chaetochromin D, which were new naphtho-γ-pyrone dimers produced by Chaetomium sp ., indicated strong inhibition (IC₅₀ 0.13-0.24 μ/ml) in LB and MB cell cultures, and ustilaginoidin A, which was a naphtho-γ-pyrone dimer produced by Ustilaginoidea virens , inhibited at higher concentration than chaetochromins by several-folds in LB and MB cultures.     

Surgical Treatment of Lung Cancer in Patients over the Age of 70 Years

The number of elderly patients receiving surgical treatmentfor lung cancer is rapidly increasing. There were 199 patients over the age of 70 yr among 1,210 patientswho underwent lung resection for lung cancer. Among the 199,156 were between the ages of 70 and 74, 36 between 75 and 79and seven over the age of 80. One hundred and sixty-nine received lobectomy, 25 pneumonectomyand five a smaller lung resection. Mediastinal lymph node dissectionwas carried out in 145 cases. The crude 5-yr survival rate of84 patients who were operated upon during the period from 1962to 1976 was 30% and was similar to that of patients less than70 yr old. Because of the higher postoperative mortality rateof patients with pneumonectomy and with combined resection oflung and neighboring organ(s), 16% and 15% respectively, itwas considered reasonable that the use of these two operativemodalities for elderly patients should be limited. From these results patients over the age of 70 yr can be saidto be a proper target of lung surgery for lung cancer when alobectomy shows that such surgery is indicated.     

Effects of cytokines on hematopoietic progenitor cells in cord blood,in bone marrow,and in peripheral blood mobilized by chemotherapy and G-CSF

We compared the effects of various combinations of cytokines (stem cell factor [SCF], interleukin [IL] ?3, IL-6, granulocyte-colony stimulating factor [G-CSF], erythropoietin [EPO]) among the growth of human hematopoietic progenitor cells from cord blood (CB), bone marrow (BM), and peripheral blood mononuclear cells (MNC) mobilized by chemotherapy and G-CSF (PB) in a semi-solid medium. Macroscopic colonies, that were visible to the naked eye, were formed from PB-MNC within 1 week even without cytokines. They consisted of blasts containing macrophage-like cells with immature nuclei on Wright stain, and were strongly accelerated by IL-3. Macroscopic colonies were also formed from CB-MNC. However, they appeared after 1–3 weeks and synergistic effects of SCF with other cytokines, especially EPO, were prominent. Macroscopic colonies were not formed from BM-MNC. Granulocyte-colony stimulating factor was effective in increasing colony forming units of granulocyte macrophage from BM-MNC and they appeared between 1 and 2 weeks. These results suggested that the quality of hematopoietic progenitor cells was different among blood sources. This might lead to different bone marrow recovery patterns after transplantation of each blood source. The appropriate cytokines should be added to evaluate their exact potential.     

Ex vivo expansion of umbilical cord blood hematopoietic progenitor cells by combinations of cytokines

Ex vivo expansion of hematopoietic progenitor cells in the umbilical cord blood mononuclear cells (CB-MNC) was investigated in liquid culture system with various combinations of cytokines (stem cell factor [SCF], interleukin [IL]-3, IL-6, granulocyte-colony stimulating factor [G-CSF], erythropoietin [EPO], and interferon [INF]-γ). Non-lineage-committed hematopoietic progenitor cells and lineage committed hematopoietic progenitor cells were represented as CD34⁺CD38^? and CD34⁺CD38⁺ subpopulations, respectively. Although absolute CD34⁺CD38^? cell numbers decreased even in the presence of multicytokines, the combinations of SCF plus IL-6 and SCF plus IL-3 plus IL-6 plus INF-γ were significantly effective in maintaining CD34⁺CD38^? cells than the other combinations (P < 0.05). After 4 weeks of culture, CD34⁺CD38^? cells disappeared in all combinations of cytokines. Absolute CD34⁺CD38⁺ cell numbers increased in the presence of cytokines. Maximal expansion of CD34⁺CD38⁺ cells were observed in the combinations of SCF plus IL-3 plus IL-6 plus EPO (19.8 ± 3.3 -fold) and SCF plus IL-3 plus IL-6 plus G-CSF (18.3 ± 2.6). The combination of SCF plus IL-3 plus IL-6 was also effective to expand CD34⁺CD38⁺ cells (15.8 ± 3.9). However, the expansion was transient and they decreased to zero within 3 weeks. In the combinations of SCF plus IL-6 and SCF plus IL-3 plus IL-6 plus INF-γ, maximal expansion was inferior to the others but CD34⁺CD38⁺ cells were maintained more than 4 weeks. These results suggested that the indication of CBT can be expanded into older children by ex vivo augmentation of CB hematopoietic progenitor cells using multi-cytokines.     

Proximal Renal Tubular Acidosis Associated with Glycogen Storage Disease, Type 9

ABSTRACT. A 21/2-year-old Japanese boy with glycogen storage disease, type 9, developed proximal renal tubular acidosis (RTA). The RTA significantly improved in response to cornstarch therapy, implying a direct causal relationship between subtle metabolic derangements in glycogen storage disease, type 9, and proximal RTA.