Comparison of cisplatin and 5-fluorouracil chemotherapy protocols combined with concurrent radiotherapy for esophageal cancer

Purpose  The optimal chemotherapeutic protocol for the treatment of esophageal cancer has not yet been established. This study was performed to identify the differences in toxicity and completion rates of various chemotherapy protocols with that goal in mind. Materials and methods  A total of 61 patients with esophageal cancer were enrolled in this study between June 2002 and January 2004. The total radiotherapy dose was 64 Gy. Three chemotherapy protocols were used. Arm A comprised daily low-dose cisplatin (CDDP) and 5-fluorouracil (5FU) (CF protocol) (3 mg/m² and 180 mg/m², respectively). Arm B was intermediate between arm A and C (CDDP 7 mg/m² and 5FU 250 mg/m² on days 1–5, 8–12, 29–33, and 36–40). Arm C comprised two courses of standard CF (CDDP 70 mg/m² on day 1 and 5FU 600 mg/m²/24 h on days 1–4). Results  Although there were no significant differences in hematological toxicity between the protocols, leukocytopenia was slightly milder in arm A. Nausea was significantly more severe in arm C. The completion rate was higher in arm A. The 3-year survival rates were 40%, 31%, and 62%, respectively. Conclusion  The daily low-dose CF protocol showed a trend of mild toxicity regarding leukocytopenia. However, we could not find statistical difference between arms. It also showed a better completion rate than the other two arms.     

Hypercalcemia Associated with the Ectopic Expression of 25-hydroxyvitamin D3-1α-hydroxylase in Diffuse Large B-cell Lymphoma

An 82-year-old man was transferred to our hospital due to impaired consciousness. His albumin-corrected calcium level was 14.2 mg/dL, intact parathyroid hormone (PTH) and PTH-related protein levels were reduced, and his 1,25-dihydroxyvitamin D [1,25(OH)₂VitD] level was elevated at 71.5 pg/mL. Computed tomography revealed masses on the bilateral ribs. The mass on the rib was biopsied and diagnosed as diffuse large B-cell lymphoma (DLBCL). Immunostaining of the biopsy sample with the anti-CYP27B1 antibody revealed the ectopic expression of 1α-hydroxylase in the lesion. We herein report a rare case of hypercalcemia induced by the overproduction of 1,25(OH)₂VitD in DLBCL ectopically expressing 1α-hydroxylase.     

Flow cytometric DNA analysis of thyroid carcinoma

Abnormal DNA content has been considered as an additional criterion for determining the biological behavior of a tumor. Flowcytometric DNA analysis was done on 121 patients with thyroid carcinoma encountered during the period between 1975 and 1987. Tumor tissues were sampled from paraffin-embedded blocks and the histology of thyroid carcinoma found to consist of 91 papillary, 23 follicular, 2 medullary, 1 squamous cell and 4 anaplastic carcinomas. The incidence of aneuploidy in thyroid carcinoma was 7.4 per cent (9 patients) while that of diploidy was 92.6 per cent (112 patients). The aneuploid specimens consisted of 6 papillary, 1 follicular, 1 medullary and 1 anaplastic carcinomas and, of 4 anaplastic carcinoma patients with subsequent death within 6 months, only 1 was aneuploid. As an indicator of proliferative potential, S-phase fraction (SPF) was also determined by flow cytometry, but this could not be used as an independent prognostic factor. The aneuploid patients showed a significantly decreased survival rate (p<0.01). Thus, although DNA measurement proved useful for predicting the survival of aneuploid patients, there is some discrepancy between DNA content and the biological behavior of the tumor.     

Meta-analysis of the second collaborative study of adjuvant chemoendocrine therapy for breast cancer (acetbc) in patients with stage ii, estrogen-receptor-positive breast cancer

The second 5-year study of postoperative adjuvant therapy in patients with breast cancer between 1985 and 1988 was performed by the Study Group for Adjuvant Chemoendocrine Therapy for Breast Cancer (ACETBC). This report describes the results of a meta-analysis of the outcome. A total of 3012 patients with stage II, estrogen-receptor-positive primary breast cancer who underwent radical surgery (total mastectomy with at least axillary dissection) were eligible for the analyses. On the day of surgery, all patients received 13 mg/m² of mitomycin C (MMC) intravenously. Patients were then given one of two adjuvant chemoendocrine therapies for 2 years: regimen A, consisting of tamoxifen citrate (TAM) 30 mg/day, or regimen B, consisting of TAM 30 mg/day plus tegafur (Futraful, FT) 600 mg/day. The results from all eligible patients were included in a meta-analysis according to the method of Petoet al. The odds reduction rate was 12 ± 13% (log-rank test,p = 0.35) for the 5-year survival rate and 16±10% (log-rank test, p = 0.093) for the 5-year non-recurrence rate. In terms of the 5-year non-recurrence rate, regimen B (with FT) yielded slightly, but not significantly, better results than regimen A. In addition, stratified analyses were carried out with respect to the 5-year non-recurrence rate. Regimen B (with FT) yielded significantly better results than regimen A in patients with four or more positive axillary nodes (log-rank test,p = 0.039) and yielded slightly, but not significantly, better results than regimen A in premenopausal patients (log-rank test,p = 0.079).     

Cross‐sectional multicenter observational study of psoriatic arthritis in Japanese patients: Relationship between skin and joint symptoms and results of treatment with tumor necrosis factor‐α inhibitors

Psoriatic arthritis (PsA) is an inflammatory arthritis with as yet unclear pathophysiology. This retrospective, multicenter, cross‐sectional study was conducted in 19 facilities in western Japan and aimed to identify patients’ characteristics and factors that affect the results of treatment with biologic agents. Of 2116 patients with psoriasis, 285 (13.5%) had PsA. Skin manifestations preceded joint manifestations in 69.8%, the onset was simultaneous in 17.2%, whereas PsA preceded skin manifestations in 2.5%. Peripheral arthritis was most common, occurring in 73.7%, compared with axial disease in 21.8%, enthesitis in 23.5% and dactylitis in 35.4%. Patients with severe skin manifestations were significantly younger at onset (P = 0.02) and more frequently had axial disease (P < 0.01). Biologic agents were used in 206 patients (72.3%), anti‐tumor necrosis factor (TNF)‐α antibodies being prescribed first to 157 of them. Anti‐TNF‐α antibodies were continued by 105 participants and discontinued by 47, the remaining five patients being lost to follow up. Patients who discontinued anti‐TNF‐α antibodies were significantly older than those who continued (55 vs 51 years, P = 0.04) and significantly older at onset of joint manifestations (50 vs 44 years, P = 0.01). Multivariate analysis revealed that patients over 50 years significantly more frequently terminated anti‐TNF‐α antibodies (P < 0.01). In conclusion, patients with PsA and severe skin manifestations have earlier onset and axial disease, which seriously impacts on quality of life. Anti‐TNF‐α antibodies were generally effective enough to continue but less so in patients aged over 50 years. Further detailed research is needed.     

COLONIC MICROPERFORATION AFTER ENDOSCOPIC PIECEMEAL MUCOSAL RESECTION

A 45‐year‐old woman had an Is + IIa laterally spreading tumor (granular type), 30 mm in size, located in the lower rectum. This lesion was removed by endoscopic piecemeal mucosal resection (EPMR) combined with argon plasma coagulation. The area of the defect after EPMR was completely closed with endoscopic clipping to avoid delayed bleeding and perforation. Perforation, such as tearing of the muscle layer, was not recognized during EPMR. However, abdominal radiography, which the authors perform routinely after EPMR, showed free air near the rectum. The patient did not complain of abdominal pain except for anal discomfort, and conservative treatment with antibiotics was selected. The surgeon inserted a tube from the anus to prevent expansion of the rectum and to keep unwanted digestive juices from leaking out from the damaged area. The maximum C‐reactive protein level was 17.2 mg/dL 2 days after EPMR, and on day 6 was <1.0 mg/dL. An oral diet was resumed, and the patient was discharged at 8 days after the EMR.     

Effects of a novel β3‐adrenoceptor agonist,AJ‐9677, on relaxation of the detrusor muscle: An in vitro study

Objectives: To examine the relaxant effects of AJ‐9677, a novel β₃‐adrenoceptor agonist, on the isolated rat, monkey and human detrusor muscle. Methods: The isolated detrusor strips of rats, monkeys and humans were mounted in organ baths containing Krebs solution. By the cumulative addition of β‐adrenoceptor agonists (isoproterenol, AJ‐9677, CL 316,243 and salbutamol in rats; isoproterenol, AJ‐9677 and CL 316,243 in monkeys and humans), concentration–relaxation curves were obtained. The maximal relaxation responses and pEC₅₀ values were calculated. In rats, concentration–relaxation curves to isoproterenol and AJ‐9677 were obtained in the presence and absence of propranolol or SR 59230A. Results: Isoproterenol, AJ‐9677, CL 316,243 and salbutamol induced concentration‐dependent relaxation in rats. The rank order of their relaxing potency in the rat detrusor muscle was AJ‐9677 > isoproterenol > CL 316,243 > salbutamol. Isoproterenol and AJ‐9677 also produced a concentration‐dependent relaxation with high potency in monkeys and humans, whilst CL 316,243 had low relaxing potency. According to the antagonist studies in rats, propranolol and SR 59230A caused a rightward shift of the concentration–relaxation curves to isoproterenol or AJ‐9677, respectively. Conclusions: AJ‐9677 has a high relaxant potency on the rat, monkey and human detrusor smooth muscle, and it may have the potential to treat overactive bladder.     

Effects of addition of salt to bread on IgE antibody responses

The effect of the addition of NaCl to bread on antigen-antibody reaction involving IgE was examined. We compared the antigen-antibody reaction involving IgE between dough including NaCl and that not including NaCl. Crude proteins extracted from the dough including NaCl showed weaker antigen-antibody reactions than proteins from the dough no added NaCl on allergic tests such as precipitin ring test with human-specific IgE, and the IgE binding activity on ELISA. The crude proteins extracted from the dough with NaCl or without NaCl were applied to an affinity chromatography column of immobilized-trypsin chitin. Then proteins having affinity were recovered. The recovered proteins were separated by SDS-PAGE. Each protein was examined for the IgE binding activity on ELISA. When the amount of protein in dough including NaCl was compared with that in dough without NaCl, a significant difference in the amount of ovomucoid between the two samples were confirmed. The IgE binding activity of baked bread was studied as well. Crude proteins of baked bread made from dough including NaCl showed weaker IgE binding activity on ELISA than proteins of baked bread made from dough without NaCl. The importance of NaCl as an ingredient of baked bread was confirmed.     

The prognosis and treatment effectiveness of de novo aneurysm formation after radiation therapy for brain tumor

Neurosurgical Review - Radiation therapy is a well-established, minimally invasive method of treating brain tumors. In recent years, the number of post-radiotherapy patients has increased, and...