Combination therapy with interferon alpha and beta to chronic hepatitis C

To increase the sustained response (SR) rate in chronic hepatitis C (CHC), we tried a combination therapy with interferon (IFN) alpha and beta. Fifty patients were grouped into 4 groups: group 1H (n=9), HCV serotype 1 and high HCV-RNA titer (over 6 log copies/ml); group 1L (n=11), HCV serotype 1 and low HCV-RNA titer (less than 6 log copies/ml); group 2H (n=23), HCV serotype 2 and high HCV-RNA titer; group 2L (n=7), HCV serotype 2 and low HCV-RNA titer. They were given a total dose of 768 MIU which included natural IFN beta (6 MIU) once daily for 28 consecutive days and then natural IFNalpha (10 MIU) three times a week for 20 weeks. Forty-nine patients with CHC receiving IFN alpha at total dose of 480 MIU served as single therapy group. In combination group, SR rate was achieved in 62%, 44% in 1H, 45% in 1L, 70% in 2H, and 86% in 2L, respectively. In single group, SR rate was achieved in 45, 14, 58, 60, and 82%, respectively. There was no significant difference for SR rate between combination group and single group. However, in patients with HCV-RNA titer between 6-7 log copies/ml of 1H group, SR rate in combination group (67%, 4/6) was significantly higher than that of single group (18%, 3/17) (p<0.05). These data suggest the usefulness of combination therapy with IFN alpha and beta in CHC with serotype 1 having moderately high HCV-RNA titer.     

Measuring quality of life in patients with breast cancer: a systematic review of reliable and valid instruments available in Japan

BACKGROUND: Little is known about the availability and psychometric properties of instruments to measure quality of life (QOL) in clinical research on Japanese patients with breast cancer. The purpose of this systematic review is to find reliable and valid instruments available in Japan, and to summarize their characteristics. METHODS: Instruments available in Japan were found through a systematic search of the literature. Each instrument identified was evaluated for item development, reliability, validity, interpretability and utility. RESULTS: Six questionnaires to measure health-related QOL (the QOL-ACD, the EORTC QLQ-C30, the EORTC QLQ-BR23, the FACT-B, the SF-36, the WHO/QOL-26) and five scales to quantify the psychological burden (the STAI, the POMS, the SDS, the HADS, the GHQ), for which reliability and validity have been documented, are available in Japanese. All instruments were developed in foreign countries except for the QOL-ACD. Two of the QOL questionnaires were specific to breast cancer (the EORTC QLQ-BR23, the FACT-B). Though the measurements can be interpreted in some manner, the meaning of change scores over time has been documented for only three instruments (the EORTC QLQ-C30, the FACT-B, and the GHQ). CONCLUSIONS: The review provides grounds for designing and implementing quantitative research on QOL of breast cancer patients in Japan. Methodological challenges, however, continue, particularly for validating instruments with regard to various study populations of Japanese people and demonstrating the clinical importance of change scores.     

Factors associated with diagnostic delay of oral squamous cell carcinoma

Shortening the diagnostic delay from the onset of symptoms to the final diagnosis leads to early cancer detection and a reduced incidence of advanced cases. To analyze factors contributing to delays in the diagnosis of oral cancer, information was collected from the medical charts of 152 consecutive patients with oral squamous cell carcinoma, and factors associated with diagnostic delay were examined retrospectively. No characteristic was significantly associated with delay caused by patients. Referral by a non-initial professional, initial visit to a dentist, T1 cancer, and the presence of an ulcerative lesion were significantly associated with delay caused by the initial professionals. Patients with N0 were significantly associated with diagnostic delay caused by the final professional. These results re-emphasize the important role of the initial professional, particularly the dentist, and the diagnostic difficulty posed by ulcerative lesions and small-sized or early-stage oral cancer.     

Characterization of autofluorescence in oral squamous cell carcinoma

This study was carried out to evaluate the clinical characteristics of autofluorescence in oral squamous cell carcinoma (SCC) and analyze the fluorescent substances using high-performance liquid chromatography (HPLC). Fifty of 55 oral SCCs (91%) emitted orange or red fluorescence, which was recorded by fluorescence photography. The intensity of the fluorescence significantly correlated with the T and N categories of the cancers, but did not show statistical difference for the types of clinical appearance and primary sites. Protoporphyrin and coproporphyrin were identified as the fluorescent substance in the SCC samples, and the elution patterns on HPLC revealed some porphyrin compounds as specific to oral cancer. These results suggest that the autofluorescence in oral SCC correlates with the progression of lesions, and that fluorescent substances such as protoporphyrin are produced in association with the cancerous tissue.     

Direct coronary reimplantation for anomalous origin of the right coronary from the left sinus of Valsalva

A 41-year-old man was diagnosed with anomalous origin of the right coronary artery from the left sinus of Valsalva with a slit ostium. Surgery was offered to the patient in view of his young age and the unpredictable natural history of the disease. Direct reimplantation of the right coronary artery to the right sinus was performed under cardiopulmonary bypass. The patient recovered uneventfully. Postoperative coronary angiography showed good patency of the reconstructed artery while exercise thallium scintigraphy showed no ischemic change. Excellent longevity of the directly reimplanted coronary artery can be expected.     

Metastatic carcinoid tumor in the orbit

In 1991, a carcinoid tumor of the duodenum with metastasis in the regional lymph nodes was resected in a 39-year-old-man. A metastasis in the mediastinum was found and was resected in 1996. In 1999, a metastasis in the left lung was discovered and was excised. In 2001, he noticed right-sided diplopia, and a computed tomography (CT) scan disclosed a tumor of 2 cm diameter in the right orbit with infiltration to the frontal sinus. The tumor was resected, and was diagnosed metastatic carcinoid tumor. An orbital metastasis of carcinoid tumor is rare, and only about 30 cases have been reported in the English literature. The rarity metastasis of carcinoid tumors in the orbit prompted us to report this case.     

ISOLATED WELL-FORMED INTESTINAL TISSUE IN THE UMBILICAL CORD: A Variant of Cyst of Omphalomesenteric Duct

An extremely rare abnormality, a variant of omphalomesenteric duct, was observed in the umbilical cord 1 cm from the entry point into the abdominal wall, which itself was as an isolated mass of well-formed intestinal tissue free of structural defects. This intestinal tissue seems to be the remnant of an intestinal loop from caudal limb of midgut following physiological herniation during the third month of gestation.     

Forensic toxicologic analysis of methamphetamine and amphetamine in body materials by gas chromatography/mass spectrometry

Summary Qualitative and quantitative analysis of methamphetamine and amphetamine in biologic materials was carried out by gas chromatography/mass spectrometry. A deuterium-labeled methamphetamine was employed as an internal standard with a detection limit of 50 pg and absolute stability and reproducibility. Blood was found to be the best material for estimation of the toxicity of the stimulant drug. It can be replaced by muscle which contains methamphetamine concentrations close to those of blood. The authors' classification of the toxic blood levels of methamphetamine from therapeutic to fatal doses was confirmed by additional data obtained from new case studies.Supported by a grant-in-aid for scientific research in 1983/1984 from the Japanese Ministry of Education     

Pathomorphological study of thorotrast-related intrahepatic cholangiocarcinoma--a comparison with non-thorotrast cases

Thirty-five autopsy cases of Thorotrast (TH)-related intrahepatic cholangiocarcinoma were morphologically studied with a comparison to 45 non-TH cases. Latent periods ranged from 25 to 48 years, with a mean of 34.1 +/- 6.6 years. As to tumor location, the peripheral-middle type, in which the main tumor was located in the periphery to middle portion of the liver, was the most common (89.2%) in the TH-related cases, and the hilar type, in which the main tumor was located in the hepatic hilum, was the most common (78.8%) in the non-TH cases. However, there was no close relationship between the distribution of TH deposits and tumor location by soft-X ray examination of the liver slices. Grossly, the massive type with an infiltrative growth was the most common both in the TH- and non-TH cases. Histologically, there were no remarkable differences between the two groups, and tubular adenocarcinoma with varying degrees of fibrous stroma was the most common. In noncancerous areas, proliferation of the bile ducts with slight to moderate atypism and ductular proliferation around Glisson's capsule were found in 30%, and 10%, respectively, of the TH-related cases. However, such changes were also found in the non-TH cases at almost the same incidence.