Antitumor Effect of 3-[(4-Amino-2-Methyl-5-Pyrimidinyl) Methyl]-1-(2-Chloroethyl)-1-Nitrosourea (ACNU) on Human Colon Carcinomas Transplanted into Nude Mice

Two human colon carcinomas serially transplanted into nude micewere used for experimental chemotherapy by 3-[(4-amino-2-methyl-5-pyrimidinyl)methyl]-1-(2-chloroethyl)-1-nitrosourea(ACNU). Human colon carcinomas Co-3 (well-differentiated adenocarcinoma)and Co-4 (poorly differentiated adenocarcinoma), were transplantedsubcutaneously into the backs of BALB/c male nude mice. Tumorsize was measured three times a week, and treatment was startedwhen the estimated tumor weight reached 100 to 300 mg. Twentyand 40 mg of ACNU per kg was administered intravenously, once,dissolved in 0.2 ml of normal saline. There were marked tumorregression and histological tumor cell destruction in Co-4,whereas no effect was observed in Co-3. Microangiography revealed a similar vascular network in Co-3and Co-4. Whole-body autoradiography was performed 5, 30, 180and 360 minutes after 20 mg (286 µC₁) of [ethylene-2-¹⁴C]-ACNUper kg was injected. ACNU concentration in the Co-3 tumor reacheda peak 30 minutes after injection and diminished promptly withthe decrease of ACNU in the blood, whereas in Co-4 tumors ACNUwas retained in the tumor until 360 minutes after ad ministration.The effect of ACNU was thought to be correlated with the concentrationof the drug in the tumor. Present address: Department of Surgery, Kitasato InstituteHospital, Tokyo, Japan.     

Clinical and biological aspects of acute lymphoblastic leukemia in 62 infants: Retrospective analysis of the Tokyo Children's Cancer Study Group

BACKGROUND: As a first step to formulate a new treatment strategy for refractory acute lymphoblastic leukemia (ALL) in infants, clinical results and immunophenotypic and cytogenetic data were analyzed and compared with those from overseas. METHODS: There were 62 infants with ALL who were treated between 1977 and 1995 at 30 institutions affiliated with the Tokyo Children's Cancer Study Group. Clinical and laboratory data obtained from these infants (all under 1 year of age) were retrospectively studied. RESULTS: The morphological diagnoses were FAB-L1 for 51 patients (82.2%) and FAB-L2 for 11 patients (17.8%). Hepatomegaly and splenomegaly were found in 40 (70.0%) and 40 patients (68.3%), respectively. The mean (+/- SEM) leukocyte count at diagnosis was 205,900 +/- 35,700/microL. The involvement of the central nervous system was evident in nine of 36 patients who were subjected to lumbar puncture, while three of these nine patients were free of neurological symptoms at diagnosis. Thirty-one patients (55.4%) were CD10 negative and 14 (25.0%) were CD10 positive. Thirty-one of 47 patients (65.9%) exhibited chromosomal abnormalities, including 28 patients (59.6%) with 11q23 abnormalities. Rearrangements in the MLL gene were found in nine of 13 infants (69.2%) examined. Translocation of 11q23 and/or MLL gene rearrangement (11q23/MLL) was significantly associated with the absence of the CD10 antigen. Hyperleukocytosis of more than 50,000/microL and 11q23/MLL gene rearrangements were related to a poor prognosis. The probability of an event-free survival in 62 infants was 13.1 +/- 4.8% at 48 months. CONCLUSIONS: New therapeutic strategies and large-scale cooperative prospective trials are needed to improve the prognosis of ALL in infants.     

Impact of thrombocytosis and C-reactive protein elevation on the prognosis for patients with renal cell carcinoma

AIM: C-reactive protein (CRP) elevation is reportedly a prognostic factor in patients with renal cell carcinoma (RCC). Thrombocytosis has recently been reported also to be a prognostic factor in RCC and, like CRP, to be related to inflammatory cytokines such as interleukin-6. The aim of this study was to evaluate the importance of both thrombocytosis and CRP elevation in tumor recurrence and prognosis for patients with RCC. METHODS: The clinical records of 178 patients who underwent radical nephrectomy were reviewed. Thrombocytosis was defined as a platelet count >or=350,000/mm(3), and CRP elevation was defined as a CRP level >or=1.0 mg/dL. Disease-free survival and cause-specific survival rates were calculated. Independent predictors for recurrence and prognosis were determined. RESULTS: Patients with thrombocytosis and patients with elevated CRP levels had significantly higher pathological T stage, clinical stage, tumor size, histological grade, and percentage of microvascular invasion than did patients without THC and patients with CRP levels <1.0 mg/dL, respectively. There was a significant correlation between platelet counts and CRP levels. Multivariate analysis showed that distant metastasis, tumor size, grade 3 components, and CRP elevation were independent predictors for prognosis but thrombocytosis was not. In N0M0 RCC patients, tumor size, microvascular invasion, and CRP elevation were independent predictors for recurrence. CRP elevation and tumor size were independent predictors for prognosis. CONCLUSIONS: Platelet count and CRP level are strongly correlated in patients with RCC, but only CRP elevation is an independent predictor for recurrence and prognosis.     

Percutaneous Access of the Epicardial Space for Mapping Ventricular and Supraventricular Arrhythmias in Patients With and Without Prior Cardiac Surgery

Percutaneous Epicardial Access . Introduction: There is a paucity of data on the success rates of achieving percutaneous epicardial access in different groups of patients. Methods and Results: Percutaneous epicardial access was attempted in 137 patients having 149 procedures; 19 patients had supraventricular tachycardia (SVT), 25 patients had idiopathic VT and 93 patients had scar‐related ventricular tachycardia (VT). Ten patients had prior cardiac surgery. Successful epicardial access was achieved in 133 of 149 (89.3%) procedures. Access was achieved in 17 of 19 (89.5%) patients with SVT, all patients with idiopathic VT, 80 of 93 (86.0%) patients with scar‐related VT and in 2 (20%) patients with prior cardiac surgery. Attempted access failed in 16 patients; 8 had prior cardiac surgery and 3 had prior pericarditis. After an initial procedure, repeat access was attempted in 15 patients, 5.1 ± 5.4 months after initial epicardial mapping and ablation. Access was successful in 13 (86.7%) and failed in 2 patients who had pericarditis after their first procedure. Only 4 patients were given intrapericardial glucocorticoid at their first epicardial procedure. Prior cardiac surgery and a history of pericarditis predicted unsuccessful access (P < 0.01). Complications (9 patients) included pericardial bleeding (80–250 mL) and intraabdominal bleeding. Conclusions: In patients without prior cardiac surgery, percutaneous epicardial access can be obtained in the majority of patients. Prior cardiac surgery precludes access in the most patients and when possible adhesions may limit catheter movement. Repeat access is possible in the majority of patients without the installation of intrapericardial glucocorticoid at the first procedure. (J Cardiovasc Electrophysiol, Vol. 21, pp. 406–411, April 2010)     

Lung Cancer in Chromate Workers--Analysis of 11 Cases

We have experienced 11 cases of lung carcinoma in workers ata chromate factory during the past 14 years. All patients weremales. The age of onset ranged from 41 to 68 years. Ten of the11 were heavy smokers. The time of exposure to chromate wasfrom 17 to 29 years and the average was 23.9 years. Seven patientshad perforation of their nasal septa. The primary sites of thecancers were from the lobar to the subsegmental bronchi. Therewere nine squamous cell carcinomas and three small cell carcinomas.Four squamous cell carcinomas were hilar type early stage cancersand two of them were found in one patient at the same time.The chromium content of the lung tissue in the seven patientstested was from 13.9 to 2,368.4 µg/g of dry tissue andwas higher than that of lung cancer or non-lung cancer caseswithout chromate exposure. There was no severe dysplasia ofthe bronchial epithelium in these 11 patients.     

Extraperitoneal laparoscopic Lich–Gregoir antireflux plasty for primary vesicoureteral reflux

Abstract We performed laparoscopic Lich–Gregoir antireflux plasty on 4 patients with primary vesicoureteral reflux. All procedures were conducted using the extraperitoneal approach. The average surgical time was 230 min. There were no complications. After surgery, voiding cysturethrograms showed no reflux in all patients.     

Evaluation of Mediastinal Abnormality by Xerotomography

Mediastinal structures of 49 patients were demonstrated by Xerotomographyand compared with the findings of ordinary film tomography.Our results suggest that Xerotomography is superior to filmtomography in demonstrating the figures of the tracheobronchialtree and blood vessels in the mediastinum. Anteroposterior Xerotomographyis recommended for demonstrating the abnormal swelling of rightand left paratracheal lymph nodes and tracheo-bronchial lymphnodes which affect the normal figures of the tracheobronchialtree and blood vessels. Right posterior oblique Xerotomographyat an angle of 55 degrees is valuable for evaluation of thepretracheal and subcarinal lymph nodes. Because the tracheobronchialwall was demonstrated clearly Xerotomography was sometimes ableto determine whether the lymph node metastases stayed withinthe lymph nodes or infiltrated into the bronchial wall.     

Somatoform pain disorder in a case of Klinefelter's syndrome with multiply operated lower back

Abstract We report a case of Klinefelter's syndrome with multiply operated low back (MOB). Psychological and/or psychosocial problems related to MOB have been of recent interest in the field of orthopedic surgery. Based on psychiatric interviews, this case was diagnosed as a somatoform pain disorder of the DSM-III-R somatoform disorders. In addition to psychological problems, the pain was partly explicable by severe osteoporosis, which was prematurely caused by endocrinological disturbances associated with Klinefelter's syndrome. Patients with this syndrome are more likely to develop severe osteoporosis. In the presenile period of Klinefelter's syndrome with severe osteoporosis, liaison psychiatrists may pay attention to somatoform disorders (e.g. somatoform pain disorder and conversion disorder) linked with the MO.     

Intra-operative secretin test for the rapid evaluation of curative operation in a case of Zollinger-Ellison syndrome

The intra-operative measurements of serum gastrin levels and an intra-operative secretin test were carried out as the rapid evaluation of curative operation in a case of Zollinger-Ellison syndrome (ZES). In this case, pre-operative investigations suggested that the tumours were located in the head of the pancreas and the duodenal wall. The surgeon planned a pan-creato-duodenectomy. Serum gastrin levels were reduced after the resection of the head of the pancreas and duodenum, and the secretin test after resection was negative. The surgeon ensured that gastrinomas were resected completely during the operation. The secretin test carried out 1 month post operatively was also negative. The patient has experienced no further complications, to date. This case suggests that intra-operative secretin test is useful for the rapid evaluation of curative operation in case of ZES.