Renal cyst puncture under ultrasound guidance: complications of ethanol injection

Under ultrasound guidance, we treated 25 cases of renal cyst with 99% ethanol instillation to prevent the recurrence of this disease from January 1985 to June 1987. Patients' age was from 17 to 85 years old with the average age of 63 years. Twelve cases were men, and 13 cases were women. Among the 25 cases, eleven were asymptomatic and 14 showed clinical features of lumbago, microhematuria, hypertension or proteinuria. The aspirated site was the right side in 9, left side in 14 and bilateral kidneys in 2 cases. Subsequently, cyst puncture was carried out 27 times. We encountered 12 complications following puncture. These complications were derived from the puncture itself or caused by the ethanol instillation. Flank pain caused by the injection of ethanol, nausea, causalgia or a feeling of drunkenness appeared immediately after the inoculation procedure. However, no serious complications such as pneumothorax, perirenal hematoma or infection were recognized. Some complications arose in 7 cases of 9 examples (77.8%) following more than 50 ml of ethanol injection, but the complications were observed in only 5 cases of 18 examples (22.8%) following less than 50 ml of administration. Based on these findings, ethanol injection in renal cysts appears to be useful for the treatment of this disease. In case of huge cysts when more than 50 ml of ethanol, is instilled the case should be followed up carefully after the instillation procedure.     

Clinical effect of sizofiran combined with irradiation in cervical cancer patients: a randomized controlled study. Cooperative Study Group on SPG for Gynecological Cancer.

To evaluate the clinical effect of a biological response modifier (BRM), sizofiran (SPG), combined with irradiation, a randomized controlled study was performed in patients with stage II or III cervical cancer involving the collaboration of 52 institutes throughout Japan. Patients were randomly allocated to the control group (radiotherapy only) and the SPG group (radiotherapy + SPG). SPG was given intramuscularly, 40 mg once and 20 mg twice, a week concomitantly with radiotherapy. A total 315 patients were enrolled for the study but 23 were excluded from analysis. Of the remaining 292 patients, 121 were of stage II (43 controls and 78 SPG) and 171 of stage III (49 controls and 122 SPG). The results were as follows. (1) The complete response (CR) rate among stage II patients was higher in the SPG group (91.0%) than in the control group (79.1%); also the CR rate among stage III patients was significantly higher in the SPG group (77.9%) than in the control group (61.2%). (2) The SPG group showed a significantly rapid recovery from the decreased lymphocyte counts due to radiotherapy (P less than 0.05). (3) Side effects, probably associated with SPG administration, were observed in 11 cases (5.2%).     

Anti-Jo-1 antibodies in polymyositis or dermatomyositis: evaluation by ELISA using recombinant fusion protein Jo-1 as antigen

We evaluated an enzyme-linked immunosorbent assay (ELISA) for detecting anti-Jo-1 antibodies in patients with polymyositis (PM) or dermatomyositis (DM) by use of the recombinant fusion protein Jo-1. Sera from 64 patients with PM or DM, from 80 patients with other connective tissue diseases, and from 64 healthy subjects matched for age, sex and race, were studied by the ELISA and by the double immunodiffusion (DID) method. Eight patients with myositis (six PM, one DM and one DM with malignancy) with positive anti-Jo-1 by DID also showed positive results by the ELISA method, whereas five patients with positive anti-Jo-1 by this ELISA showed negative results on DID. One of the five had non-specific results. The incidence of positive results for anti-Jo-1 with the ELISA (18.8%) was greater than that for DID (12.5%), but the difference was not statistically significant. All patients with positive results for anti-Jo-1 by DID were also positive by the ELISA. The ELISA system with the recombinant Jo-1 antigen was useful in the detection of anti-Jo-1 antibodies in patients with PM/DM.      

A Cooperative Randomized Study on Tegafur plus Mitomycin C versus Combined Tegafur and Uracil plus Mitomycin C in the Treatment of Advanced Gastric Cancer

A randomized controlled trial involving 13 institutions in Japan was conducted in order to compare the efficacy of tegafur plus mitomycin C (MMC) (Regimen A) and UFT (a combination of uracil and tegafur at a molar ratio of 4 to 1) plus MMC (Regimen B) for patients with advanced gastric cancer, who had not received any prior cancer chemotherapy. Regimen A (tegafur+MMC) consisted of 5 mg of MMC/m²/week given intravenously, and 500 mg of tegafur/m²/day given orally. Regimen B consisted of the same schedule of MMC and 375 mg of UFT/m²/day given orally. One hundred and eighty-six patients with primary gastric cancer were entered; 183 were eligible and 3 were ineligible for the study. A total of 169 were evaluable for efficacy of the treatment, including 90 patients with Regimen A and 79 with Regimen B. A response rate of 7.8% (7/90 cases) for Regimen A and one of 25.3% (20/79 cases) for Regimen B were obtained, indicating a significantly higher response rate for Regimen B according to the Criteria for Evaluating Efficacy of Chemotherapy /Radiation Therapy in the Treatment of Gastric Cancer ( P = 0.004), Regarding side effects, no marked differences in either severity or incidence were observed between the two groups. The group assigned to Regimen B showed a significant survival advantage after adjustment for major prognostic factors using a proportional hazards model ( P =0.0398). Moreover, a close correlation of antitumor effect and survival duration was found when the above criteria were used.     

Age-related changes in the interactive mobility of the hip and knee joints: a geometrical analysis

This study examined any systematic age-related change in the passive range of motion (PROM) of the hip and knee joints. Seventy-seven healthy male volunteers ranging in age from 15 to 73 years were assessed. A geometrical range of motion (ROM) analysis was applied, which could evaluate the effects of both monoarticular and biarticular muscles. The PROM of the hip joint decreased progressively with advancing age, whereas that of the knee joint remained unchanged. In addition, the interactive PROM of the hip and knee joint associated with biarticular rectus femoris and hamstring muscles also showed an age-related reduction. The progressive reduction of the ROM is probably caused by shortening of muscles or connective tissues due to reduced compliance of joint structures and degenerative changes in spinal alignment, as well as by diminished muscle stretching resulting from a decrease in daily physical activities with advancing age.     

Experimental studies of retinal glial cell proliferation on retinal surface

Our previous reports described the formation processes of epiretinal membranes composed of retinal glial cells in the experimental vitreous hemorrhage. This report presents the pathological changes of retinal glial cells, inner limiting membranes and vitreous body in the early stage of experimental vitreous hemorrhage. Using an operating microscope, 0.3 ml of autologous whole blood was injected through the pars plana into the vitreous cavity of albino rabbits. The eyes were enucleated at 3, 7, 10, 14 and 28 days after injection. Three days after injection, normal vitreous structure disappeared and vitreous fibers condensed. Seven days after injection, red blood cells were found on the retinal surface. The inner limiting membrane, composed of lamina rara and lamina densa, had a normal appearance. Where the red blood cell were present on the retinal surface, the lamina rara of the inner limiting membrane became thin. Fourteen days after injection, where glial cells showed upheaval, lamina rara disappeared and lamina densa became thin. Afterward, glial cells extruded their cytoplasmic processes onto the retinal surface. Twenty-eight days after injection, the inner limiting membranes were normal in appearance except for the area of glial cells penetrating the inner limiting membranes. The results suggested that, in vitreous hemorrhage, glial cell proliferation onto the retinal surface is an active reaction in order to engulf the debris of the red blood cells.     

Phase I/II study of docetaxel and S-1 in patients with advanced gastric cancer

The aims of this phase I/II study of docetaxel and S-1 were to determine the dose-limiting toxicity (DLT), maximum-tolerated dose (MTD), and recommended dose (RD) in the phase I part and to explore the tumour response, survival and safety in the phase II part. Patients with histologically- or cytologically confirmed unresectable or recurrent gastric cancer were eligible. Treatment consisted of intravenous docetaxel on day 1 (starting dose 50 mg m(-2)) and oral S-1 at a fixed dose of 40 mg m(-2) twice daily on days 1-14, every 4 weeks up to six cycles. Nine patients took part in the phase I portion of the study. The MTD of docetaxel was determined to be 50 mg m(-2), with the DLTs of grade 3 infection associated with grade 3 neutropenia and grade 4 neutropenia during S-1 administration. The RD of docetaxel was 40 mg m(-2) in combination with S-1 40 mg m(-2) b.i.d. The efficacy and safety of this regimen was therefore assessed in 46 patients with at least one measurable lesion. The overall response rate and estimated median overall survival were 46% (95% CI, 31-61%) and 14.0 months (8.3-17.3 months), respectively. The most common grade 3/4 toxicity was neutropenia (67% of patients), which was predictable and manageable. This regimen showed promising activity with moderate toxicities in advanced gastric cancer.     

Histochemical studies on hyaluronic acid in the developing human retina

Changes in the distribution of hyaluronic acid in the developing human retina were investigated histochemically with alcian blue staining and theStreptomyces hyaluronidase digestion method using 56 human embryos and fetuses ranging from 5 to 41 weeks of gestational age. Hyaluronic acid was first detected in the inner layer of the retina at 12 weeks. The site of accumulation extended towards the outer layer by 20 weeks. At the neonatal stage, longitudinal fibers, possibly the processes of Müller cells, were proved to contain hyaluronic acid. These findings suggest that Müller cells produce hyaluronic acid transiently from 12 weeks' gestation to the neonatal stage.