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A 35-year-old man was admitted to our department for loss of consciousness. CT and MRI revealed diffuse enhancement of the subarachnoid space surrounding the brainstem and the cerebellar sulci, without any parenchymal lesions in the brain or the spinal cord. Furthermore, gadolinium-enhanced MRI revealed a nodular lesion with heterogeneous enhancement in the right prepontine cistern, at the site from which a biopsy was obtained via right lateral suboccipital craniotomy on the day following admission. Histopathological examination of the resected specimen revealed glioblastoma multiforme. Based on the radiological and histopathological findings, the patient was diagnosed with primary leptomeningeal gliomatosis (PLG). The patient received temozolomide chemotherapy with concurrent radiotherapy and showed radiological remission, 12 months after diagnosis. However, he developed local recurrence 6 months later and died 23 months after diagnosis. Autopsy findings showed tumor cell infiltration of the leptomeninges, as well as the brain and spinal parenchyma. PLG should be considered in the differential diagnosis in patients with diffuse leptomeningeal enhancement even without parenchymal lesions on radiological imaging. A surgical biopsy is recommended for prompt and accurate diagnosis in such cases.

Background and Purpose: This retrospective study was performed to examine the relationship between the size and metastasis of hepatic lymph node in patients with liver metastasis of colorectal cancer., Patients and Methods: We analyzed a total of 163 hepatic lymph nodes that were removed during surgery from 55 patients with synchronous liver metastasis of colorectal cancer, who underwent resection of primary tumor without any residual lesions except for liver metastasi (e) s. The relationship between the size and metastasis was examined on paraffin-embedded specimens., Results: The maximal and minimal diameters were significantly greater in positive lymph nodes (n=35) than in negative lymph nodes (n=128). The area under the curve of receiver operating curve for predicting metastasis by size was 0.69. The sensitivity, specificity, and accuracy were 62.9%, 60.9%, and 61.4%, respectively, when the cutoff value was set at 7 mm., Conclusion: These findings suggest that selecting patients with hepatic lymph node metastasis based on the size of lymph nodes would be difficult.

We report a case of pseudomyxoma peritonei caused by carcinoma of the appendix, which was successfully treated with multidisciplinary treatment including modified FOLFOX6 regimen. A 45-year-old man was diagnosed as having peritoneal dissemination associated with cancer of the cecum or appendix. Seven cycles of mFOLFOX6 treatment resulted in a marked decrease in ascites and serum levels of carcinoembryonic antigen and carbohydrate antigen 19-9. At laparotomy, a diagnosis of pseudomyxoma peritonei caused by cancer of the appendix was made. Intraperitoneal lavarge with 10,000 mL 5% glucose was performed after right hemicolectomy, omentectomy and removed of mucinous peritoneal nodules. Intraperitoneal chemotherapy comprised of 3000 mL low molecule dextran and 80 mg cisplatin was added on postoperative days 7 and 14. Modified FOLFOX6 regimen was started again two months postoperatively and reached 28 cycles. The patient does not show any sign of recurrence 12 months postoperatively.

We reported an elderly case of squamous cell carcinoma of the anal canal which showed complete response following radiotherapy alone. An 86-year-old man complaining of anal bleeding and pain was admitted. Colonoscopy showed a type 1 tumor just above the dentate line. Biopsy revealed squamous cell carcinoma. Serum SCC Level before treatment was elevated (8.4 ng/mL). Magnetic resonance imaging did not show any metastatic lesions. Since the patient and his family members refused a surgical intervension and chemotherapy, he received an external radiotherapy (total dose: 60 Gy) to the pelvic space and showed complete response after radiotherapy. He is alive without evidence of recurrence about three years after the radiation, although serum SCC is slightly elevated.

We examined five cases of pseudomyxoma peritonei with treatments of cytoreduction surgery, abdominal lavage and intraperiotoneal administration of cisplatin (CDDP). These primary lesions contained one case of pancreas and four cases of appendix. Histological types contained one case of well differentiated adenocarcinoma and four cases of signet ring cell carcinoma. All cases underwent a resection of primary lesion and muconodule, abdominal lavage with saline and 5% glucose or low molecule dextran solution. CDDP was administered into the abdominal space during and after the surgery, a total amount of 100 to 400 mg/body. There were no cases of collected ascites within one year, except one case that we could not follow. There was a possibility that a short-term quality of life was improved by multidiciplinary therapy containing cytoreduction surgery and intraperiotoneal administration of CDDP.

We report a case of squamous cell carcinoma of the anal canal which showed complete response following chemoradiotherapy. A 54-year-old woman was diagnosed as having squamous cell carcinoma of the anal canal (T2N0M0 stage II). Chemoradiotherapy comprising peroral tegafur/uracil and external radiotherapy (60 Gy) to the pelvic space resulted in complete response 4 months after the initiation of the treatment. PET-CT showed recurrence in paraortic lymph node, right sacral and left pubic bone 11 months after the initiation of treatment, although the primary lesion did not relapse. The patient is now given 5-fluorouracil/cisplatin in addition to external radiotherapy (57.5 Gy) to the metastatic lymph node. This case suggests that we should take measures to prevent distant metastases in the treatment of squamous cell carcinoma of the anal canal.

Reports supporting the shortened dental arch concepts showed that the SDAs were stable in occlusion and TMJ for several years, and that effects of partial dentures on distal extension edentulous patients were unclear. However some studies are difficult to understand their conclusions after careful reviewing. Our data of 921 subjects demonstrated the prevalence of SDA, percentage of denture wearers in distal extension missing patients, and comparisons of occlusal force and masticatory performance between denture wearers and non-wearers (SDAs). To clarify the effect of prostheses, longitudinal studies or randomized controlled trials on oral function must be needed in further investigation.

Little is known about the expression levels of thymidylate synthase (TS), thymidine phosphorylase (TP), dihydropyrimidine dehydrogenase (DPD), and orotate phosphoribosyltransferase (OPRT) in diffusely infiltrating colorectal cancer. We semiquantified the mRNA levels of these enzymes in colorectal cancer specimens from 10 patients with diffusely infiltrating type and 20 patients with other types (control) matched by the maximal diameter and pathological stage, using the Dannenberg tumor profiling method. The relative expression of these enzymes did not significantly differ between diffusely infiltrating and other types of tumors. There were no significant relationships among the relative expression of the four enzymes in the diffusely infiltrating tumors, while the following three combinations were found to be correlated with each other in the control tumors: TS versus TP,TS versus DPD, and TP versus DPD. In 5 patients who received 5-fluorouracil-based chemotherapy for evaluable lesions, there were no specific relationships between the expression of these enzymes and therapeutic response. In conclusion, diffusely infiltrating colorectal cancer does not appear to have any characteristics in terms of the expression of these enzymes, which may not alter the effect of 5-fluorouracil-based chemotherapy.

Purpose: To clarify the clinical significance of determining plasma levels of vascular endothelial growth factor (VEGF) and soluble fms-like tyrosine kinase 1 (sFlt-1) in colorectal cancer, changes in plasma levels of VEGF and sFIt 1 during hepatic arterial chemotherapy were investigated in patients with liver metastases of colorectal cancer., Patients and Methods: The relationship between plasma level of VEGF or sFlt-1 and serum level of carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), or the efficacy of hepatic arterial chemotherapy was investigated in patients with liver metastases of colorectal cancer (n=19). Plasma levels of VEGF and sFlt-1 were determined by the enzyme linked immunosorbent assay., Results: There was a positive relationship between plasma level of sFlt-1 and serum level of CEA (p = 0.13). The other combinations did not show any statistical correlations. Also, in terms of the doubling time (DT), there was a positive relationship between the sFlt1-DT and the CEA-DT (p = 0.04). The levels of VEGF tended to change in accordance with the efficacy of chemotherapy. In contrast, plasma levels of sFlt-1 increased in patients with the progressive disease, whereas the levels did not decrease in patients with the partial response., Conclusions: These results suggested that (1) VEGF may be a useful tumor marker during the chemotherapy in patients, whose CEA and CA19-9 are below the cutoff, and (2) the shrinkage of liver metastases may not cause a decrease in sFlt-1 or the half-life of sFlt-1 may be considerably long.

Background and Purpose: Hepatic arterial infusion chemotherapy for unresectable liver metastases of colorectal cancer is generally indicated to patients without extra hepatic lesions. This study was performed to examine the status of hepatic lymph node metastasis as an extra hepatic lesion in patients with synchronous multiple liver metastases of colorectal cancer., Patients and Methods: A total of 111 hepatic lymph nodes were removed from 33 patients with synchronous liver metastases of colorectal cancer during resection of the primary tumor at the D2- or D3- level. The frequency of hepatic lymph node metastases and factors predictive for hepatic lymph node metastasis were examined., Results: Hepatic lymph node metastasis was detected in nine patients (27%): The sites were classified into three categories: (1) along the hepatic arteries in three, (2) in the hepato-duodenal ligament except the peri-hepatic arterial region in three, and (3) both in three. The serum level of CEA (p = 0.02), CA19-9 (p = 0.05), and the rate of lymph node metastasis of the primary lesion (p = 0.08) were higher or tended to be higher in patients with hepatic lymph node metastases than in those without. There was no significant relationship between the involvement of hepatic lymph nodes and the other clinicopathologic factors examined., Conclusion: We should note the frequency of hepatic lymph node metastasis in the treatment of unresectable liver metastases of colorectal cancer.

A 73-year-old male was diagnosed as having a Borrmann type 4 gastric cancer with multiple liver metastases. Total gastrectomy (D2) with hepatic arterial cannulation was performed. Hepatic arterial infusion therapy of MTX (50 mg or 100 mg/body) and 5-FU (500 mg or 750 mg/body) was started postoperatively. A total dose of 1,150 mg of MTX and 6,250 mg of 5-FU caused a marked decrease in the volume of liver metastases and the effect remained for 8 months (partial response). Regarding drug concentrations, serum MTX levels rapidly decreased after bolus injection through hepatic artery and corresponded to those of intravenous injection as reported elsewhere. Serum 5-FU levels were maintained as low as 1.2 micrograms/ml during 2-hr continuous infusion and rapidly decreased after the end of the infusion. These results indicate that hepatic arterial infusion therapy of MTX and 5-FU may be safe and feasible for multiple liver metastases of Borrmann type 4 gastric cancer.

The open-field test was carried out on NOD mice of both sexes between the ages of 40 to 300 days. The behavior of both sexes of mouse was observed for 3-minute periods with an interval of 20 days. The mean scores of ambulation and rearing increased at the ages of 40-80 days old, and both scores decreased more than 100 days old. The onset of overt diabetes (DM) in female mice were observed after 120 days old. After the onset of DM with great loss of body weight, the scores of ambulation and rearing were dramatically decreased. Other parameters, urination, defecation, and preening were not changed with age of both sexes. These data suggest that conspicuous weight loss with the expression of overt diabetes in NOD female mouse might correlate to decrease of the ambulation and rearing scores.

Male BALB/c mice isolated after weaning were housed two mice per cage at the age of 10 weeks. After 1 week, each pair of mice was observed for social dominance, and compared with control mice kept in isolation. The preputial gland in the socially dominant animal was histologically examined. The preputial gland consisted of a congregation of branched simple tubuloacinar gland and typical holocrine secretion on morphological examination. Acinar cells in the dominant animals were large, multiplicative and hypertrophic compared with those of controls and subordinates. Dominant animals required copious secretion for attainment and maintenance of a dominant social position. Acinar cells of subordinates were very small, flattened and atrophied because fatty secretion particles filled the luminal duct. These accumulated secretion particles pressed the acinar cells and caused degeneration. Not only luminal acinar cells but also central acinar cells and some basal acinar cells were degenerated. Electron micrographs showed that basal acinar cells in dominant animals contained many mitochondria, agranular endoplasmic reticulum and free ribosomes in the cytoplasm, whereas those of subordinates contained myelin bodies and lipid droplets. Therefore, it is suggested that the synthesis of secretion particles in acinar cells of subordinates hardly occurred.

A case of AFP producing gastric cancer successfully treated with EAP therapy is reported with a review of the literature. A 56-year-old male was admitted complaining of epigastralgia and back pain. He was diagnosed as having a gastric cancer with multiple liver metastases by endoscopy and computed tomography. Serum AFP level was 2,791,000 ng/ml and biopsy specimen showed AFP-positive tumor cells by PAP (peroxidase-antiperoxidase) method in hepatoid structure. Preoperative combination chemotherapy with etoposide, adriamycin and cisplatin resulted in a remarkable decrease in serum AFP level. Subtotal gastrectomy (R3) with hepatic artery cannulation was performed. The therapeutic effect by histological examination showed Grade 3 in the primary site and Grade 2 in both resional lymph nodes and liver metastasis.

A preliminary study was conducted to determine whether the measurement of CEA levels in gallbladder bile would be of value for diagnosis of occult liver metastases aiming at prophylactic regional hepatic chemotherapy in patients with colorectal cancer. Forty-fold dilution by normal human sera was necessary to measure CEA levels of gallbladder bile by the enzyme immunoassay (EIA). Bile CEA levels were 27.2 +/- 30.4 (M +/- SD) ng/ml in patients with benign biliary diseases (control), 248.5 +/- 426.3 ng/ml (p < 0.05, vs. control) in Dukes B, C patients, and 3,331.5 +/- 4,473.3 ng/ml (p < 0.01 vs. control, p < 0.05 vs. Dukes B, C) in patients with hepatic metastases from colorectal cancer, respectively. Bile CEA tended to demonstrate the existence of hepatic metastases more accurately than serum CEA. Our results obtained from a small number of patients suggest that patients with either elevation of bile CEA level or with a high ratio of bile CEA/serum CEA may be candidates for hepatic recurrence that requires prophylactic hepatic chemotherapy. However, it may be difficult to determine the bile CEA level at which occult liver metastases are demonstrated.

An outbreak of pertussis occurred in one room of a residential facility where 19 children aged 5 to 36 months were residing. They were prospectively surveyed to estimate the efficacy of acellular pertussis vaccine. Among the 19 residents, 9 were immunized with acellular pertussis vaccine. Among the 19 residents, 9 were immunized with acellular DTP vaccine and 10 were unimmunized. The spread of pertussis was surveyed bacteriologically and serologically for 2 months. Among the 9 immunized, 7 children acquired the laboratory-confirmed pertussis and 1 of the 7 developed the typical symptoms (whooping or paroxysmal coughing attack lasting for 14 days or more). Among the 10 unimmunized, 7 children acquired the laboratory-confirmed pertussis and 6 of the 7 developed the typical symptoms. There was no difference in the rate of secondary infection (7/9:7/10), but there was a significant difference in the rate of development of the typical symptoms (1/7:6/7 p less than 0.05). The point estimate of protective efficacy of the acellular DTP vaccine against typical pertussis was (6/10 - 1/9)/(6/10) x 100 = 81%. It was concluded from these findings that acellular DTP vaccine could not prevent the infection of Bordetella pertussis, but could prevent the development of the typical symptoms.

In some of the brains of head injury, shearing of axons and vessels caused by direct impact is seen widely in the white matter. This type of injury is designated by neuropathologists as shear injury or diffuse damage of impact type. Macroscopic lesions adjacent to the superior cerebeller peduncle and lesions of the corpus callosum are commonly seen in the brains with severe shearing injuries and the former is detected by CT scan as a high density at the quadrigeminal cistern, and this indicates occurrence of a severe shearing injury. Among 600 patients with head injuries, we managed 23 cases with pure shearing injury. These cases are classified into three groups according to the duration of coma. In the fulminant type (7 cases) the patients had severe brainstem signs including impairment of vital signs and died immediately after the injury. In the severe type (8 cases) the patients were decerebrated with normal pupillary response on admission and were severely disabled (i.e. tremor, truncal ataxia, dementia). In the moderate type (8 cases), the patients had only disturbance of consciousness for a long period, and recovered almost to the pre-injury state. Follow-up CT scan showed enlargement of the ventricles and sulci.

We report a 17-year-old female with chronic myeloid leukemia (CML) who developed monocytic crisis. She was diagnosed as chronic phase of Ph1-chromosome positive CML at 14 years old. Three years after the diagnosis of the disease, she was admitted to the hospital because of low grade fever, lethargy and marked splenomegaly. Small dose of Ara-C relieved her symptoms and splenomegaly. Six months later, however, a marked leukocytosis over 70,000/microliters were observed, and the peripheral blood smear disclosed that about 80% of the leukocytes were relatively mature monocytoid cells. Chromosomal analysis revealed additional abnormalities (double Ph1, +8, +9, +19). Lysozyme levels in serum and urine were high and NAP score was elevated. These monocytoid cells expressed receptors for IgG-Fc and C3, phagocytic activity, and monocytoid antigens which were determined by monoclonal antibodies (MY4, Mo2, OKM5). Cytochemically, almost all of monocytoid cells were positive for peroxidase and naphthol-ASD-chloroacetate esterase (CAE), but the monocytoid cells positive for non-specific esterase were limited. These data suggested that this case was monocytic crisis in CML with proliferation of CAE positive monocytoid cells. Among several types of blast crisis, monocytic crisis is extremely rare condition. The definite monocytic crisis demonstrated by this case may support the hypothesis that target cells of CML are pluripotent hematopoietic precursors.

In the living system, tissue water is considered to be composed of both free and bound water. Bound water encompasses the structural water of the cell wall and of various biological substances of high molecular weight, such as proteins and polypeptides. The present study was designed to measure thermoanalytically free and bound water on a quantitative basis in fresh brain of rats using differential scanning calorimetry (DSC). Our intention was to determine the fraction of freezable water in tissue. Freezable water in a tissue represents the fraction of free water. In the present study, freezing was conducted at a constant rate of -10 degrees C/min from room temperature to -75 degrees C by a SSC/560 S (Seiko Electronics). The system allows for calculation of the amount of free water from the differential scanning calorimetry curve employing a coloric constant of 79.4 cal/mg. Aluminium oxide was used as calorimetric reference. The fraction of bound water was calculated by subtraction of the amount of free water from that of total tissue water. Water binding to solid tissue component was estimated from tissue dry weight and the bound water fraction. Mean water content of normal gray matter in adult Wistar rats was 76.9 +/- 1.4% (SD). 88.9% of total tissue water was free whereas 11.1 +/- 2.8% (SD) was bound. Bound water of brain parenchyma amounted to 0.44 +/- 0.12 mg/mg dry weight. As compared to other tissues such as cardiac muscle and liver, brain parenchyma obviously exceeded in free water content. The total water content of serum was 94.4 +/- 1.2%; 90.7 +/- 2.6% was free and 9.3 +/- 2.6% (SD) was bound.(ABSTRACT TRUNCATED AT 250 WORDS)

A 7-year-old girl with an acute leukemia was reported whose blasts showed conversion from a T-lymphoid to a myeloid phenotype. At the onset of the disease, the blasts were negative for peroxidase and displayed FAB L1 morphology. Surface marker analysis revealed only CD7 antigen. Although complete remission was achieved, an extramedullary relapse was identified as having a several subcutaneous tumors 15 months later. Tumor cells showed the same marker expression as that of the blasts at the onset. After short term culture without an addition of any differentiation stimulators, the blast cells expressed CD2, CD3, CD4, CD8, and CD25 antigens. The karyotype was 46, XX, t(12; 21) (p11; q22). The intensive chemotherapy and radiation therapy were carried out, however, a hematological relapse occurred 12 months later. At this time, the blasts were strongly positive for peroxidase and expressed HLA-DR and CD33 antigens with disappearance of the CD7 antigen. Chromosome analysis revealed the additional abnormalities (del (7) (p15), -17, +der (17) t (17;?) (p13;?].