Role of ureteroscopic biopsy in the management of upper urinary tract malignancy

BACKGROUND: The aim of the study presented here was to examine the accuracy of ureteroscopic biopsy in the diagnosis of upper urinary tract transitional cell carcinoma (TCC) and whether nephron-sparing management (holmium YAG laser, transurethral resection or partial ureterectomy) is possible or not based on pathological diagnosis. METHODS: Forty consecutive patients underwent ureteroscopic biopsy with the use of 3-Fr cold cup forceps. Pathological diagnosis of the biopsy sample and grade or stage of surgically resected tumors were compared. In patients with grade 1 or 2 TCC diagnosed by ureteroscopic biopsy, the disease-free and survival rates determined whether nephron-sparing management was performed or not. RESULTS: There were no major complications associated with ureteroscopic biopsy. The pathological grading of the biopsy specimen was almost the same as that of the surgically resected specimen. Eighty five percent of grade 2 or 3 TCC showed muscle invasive disease. There were no significant differences in the disease-free and survival rates between the nephroureterectomy and the nephron-sparing management groups, except for grade 3 or pT3 tumors. CONCLUSION: Ureteroscopic biopsy is safe and accurate if sufficient tissue sample is obtained. Ureteroscopic biopsy should be performed in patients who require nephron-sparing management. Nephroureterectomy can be avoided if the tumor is confirmed as low-grade.     

Influence of Sex on Antipyrine Metabolism in Patients with Gastric Cancer

The metabolism of antipyrine was studied in male and femalepatients with localized gastric cancer. Antipyrine eliminationis apparently decreased in female patients, suggesting thatthe sex of patients must be taken into account in cancer chemotherapy.     

Gastrin-Enhanced Tumor Growth of a Xenotransplantable Human Gastric Carcinoma in Nude Mice

A human tumor line serially transplantable in nude mice, originatingfrom a well-differentiated papillo-tubular adenocarcinoma ofthe stomach, was established. The growth of this tumor was enhancedby daily injection of C-terminal tetrapeptide gastrin into themice. Although there was little difference in histology, thegastrin-stimulated tumor had larger glandular spaces filledwith mucin-like substance than the control tumor. ³H-thymidine uptake of the gastrin stimulated tumor was higherthan that of control, as shown by microradiography and countingof radioactivity in tissue homogenates. The plasma membrane fraction of the tumor revealed positivebinding for gastrin and the cytosol fraction contained cyclicAMP dependent- and independent protein kinases. Incubation oftumor slices with gastrin caused a conformational change inthe enzymes. Therefore we conclude that this G4 tumor line xenotransplantablein nude mice is sensitive to gastrin in its trophic and secretorymechanisms.     

A Case of Periodic Somnolence Whose Sleep was Induced by Glucose

A case of a 29-year-old man who exhibited periodic somnolence for periods ranging from 2 to 10 days from the age of 18 onward and whose 3 family members had similar episodes of somnolence is reported. The main symptoms of this case were somnolence and depressive state. The specific manifestations were paraesthesia in the limbs, alteration of body schema, exceptional liking for sweets previous to somnolence, difference in the amount of serum potassium between the interval stage and somnolence stage, and the inducement of sleep by glucose. Carbamazepine plus phenobarbital with an addition of imipramine were effective in the treatment.     

Preliminary Phase II Study of Adriamycin (ADM) in Patients with Non-Small Cell Lung Cancer (NSCLC)

A phase II study of adriamycin (ADM) (60 mg/m² was performedin 22 patients with non-small cell lung carcinoma (NSCLC). Therewere no responders in the 19 evaluable patients (16 with adenocarcinoma,two with squamous cell carcinoma and one with large cell carcinoma).The major side effects were alopecia (89%), leukocytopenia (73%),thrombocytopenia (58%) and upper gastrointestinal symptoms. Although ADM at 60 mg/m² did not appear to have sufficient antitumoractivity against NSCLC in this study, it is necessary to evaluatefurther the efficacy of ADM against NSCLC with another treatmentschedule.     

Testosterone and High Density Lipoproteins in Patients With Disseminated Gastric Cancer

The plasma concentration of testosterone and the serum concentrationof high density lipoprotein-cholesterol (HDL-C) in male patientswith disseminated gastric cancer and hepatic cirrhosis and innormal male controls were measured. The mean concentration ofHDL-C in patients with hepatic cirrhosis and in patients withdisseminated gastric cancer was significantly lower than thatin the control subjects. Positive correlation was establishedbetween HDL-C and plasma testosterone in patients with disseminatedgastric cancer. The group with low testosterone levels (<5ng/ml) had significantly lower serum albumin than the groupwith high testosterone (>5 ng/ml) in patients with disseminatedgastric cancer. Significant positive correlations were alsoobserved between survival time and either testosterone or HDL-Clevels. These observations indicate that the decreased levelsof HDL-C in patients with disseminated gastric cancer mightnot be primarily due to the decreased levels of testosteronebut rather to the nutritional status and liver funcion of theindividual.     

Clinical Trials of a New Anticancer Drug, 1-Hexylcarbamoyl-5-fluorouracil

1-Hexylcarbamoyl-5-fluororacil (HCFU) is a new anticancer drugdiscovered as a derivative of 5-fluorouracil (5-FU). In thisstudy, peculiar types of toxicity such as a hot sensation, pollakisuriaand urgency to defecate appeared in 23% of the patients, whilegastrointestinal, hematological, hepatic and renal toxicitywas very rarely observed. Blood levels of the HCFU fractionand 5-FU were maintained at high concentrations until four hoursafter administration. In a study of 30 evaluable cases withtumors in the various primary sites, good responses were obtainedin an infant with a recurrence of hepatoblastoma and in a patientwith recurrent cancer of the stomach.     

An Evaluation of the Efficacy of Preoperative Therapy for Thoracic Esophageal Carcinoma Using Endoscopic Ultrasonography

Abstract: We performed endoscopic ultrasonography (EUS) to assess the therapeutic efficacy of thoracic esophageal carcinoma treatment and compared this assessment with that of histology. The subjects were 43 patients who underwent surgical resection following preoperative chemotherapy for advanced thoracic esophageal carcinoma. The region of maximal thickness and the cross-sectional area of the tumor were measured, and the percent reduction was taken to be the degree of reduction. Total assessment of metastatic lymph nodes was made on the basis of the degree of reduction in the major axis and cross-sectional area, and the three elements of morphology, border echo and inner echo. The histological findings were classified into Grades 0 through 3 according to criteria for the management of esophageal carcinoma and compared with the EUS findings. The reduction in tumor thickness was 30% or less in 16 patients, 14 (87.5%) of whom had Grades of 0 to 1. The degree of reduction was greater than 50% in 17 patients, 15 (88.2%) of whom had Grades 2 to 3. The degree of reduction was 60% or greater in eight patients, six (75%) of whom had a Grade of 3. Reduction in the cross-sectional area was less than 50% in 19 patients, 16 (84.2%) of whom had Grades of 0 to 1. Of the 19, all who showed a reduction of 30% or less had Grades of 0 to 1. The reduction in cross-sectional area was greater than 50% in 24 patients, 20 (83.3%) of whom had Grades of 2 to 3. A significant difference was noted in the correlation between reduction in thickness and histological assessment between Grades 0 to 1 and Grade 2 (p<0.01) and between of Grades 2 and 3 (p<0.02). The correlation between reduction in cross-sectional area and histological assessment was similar to that for reduction in thickness. None of the methods produced satisfactory results in relation to assessment of metastatic lymph nodes. Assessment of accuracy by down-staging did not prove useful.     

The expression of integrin α2β1 and attachment to type I collagen of melanoma cells are preferentially induced by tumour promoter, TPA (12-O-tetradecanoyl phorbol-13-acetate)

Summary The adhesion of melanoma cells to the extracellular matrix (ECM) protein is likely to be essential in their invasive metastatic processes. Treatment with 12- O -tetradecanoyl phorbol-13-acetate (TPA), a potent protein kinase C (PKC) activator, preferentially induced the expression of α2β1 integrin, the receptor for collagen/laminin. The number of cells attached to type I collagen, but not laminin, was increased by treatment with TPA. Prior exposure to PKC inhibitors such as H-7 (20 μmol/1) and calphostin C (50μmol/1) had no effect on TPA-induced α2β1 integrin expression and cell attachment to type I collagen, whereas prior exposure to the calmodulin antagonist W-7(50 μmol/1) inhibited these TPA-induced events. The augmented adhesion was also inhibited by anti-α2 antibody. These data suggest that the increased attachment of melanoma cells to type I collagen appears to be mediated by the preferential augmentation of integrin α2β1, and the activation of calmodulin kinase, but not via the activation of PKC. Analysis of the expression of integrins and of cell attachment to ECMs is important in elucidating the mechanisms involved in the progression and metastasis of malignant melanoma.