Search

We performed esophageal endoscopy with concurrent chemo-radiotherapy for lung cancer in 19 patients. Endoscopical examination proved that seven patients (36.8%) had esophageal erosion or coating (grade 2), four patients (21.1%) had ulcer or bleeding (grade 3) confined to the radiation field, and only one patient (5.3%) had severe symptoms (WHO grade 3). There was a discrepancy between patients' symptoms and endoscopical findings. Endoscopically proven esophagitis, that is, erosion or coating (grade 2), and ulcer or bleeding (grade 3), was more frequent in the daily low-dose chemotherapy group (5/5) than in the full dose chemotherapy group (5/14) (p < 0.05). One patient with grade 3 endoscopial damage showed less recovery in spite of three months medication. In concurrent radiochemotherapy in which the radiation field includes the esophagus, careful attention should be given to radiation esophagitis, which may be underestimated when assessed on the basis of subjective symptoms alone. Therefore, endoscopy is recommended even if patients have few complaints, and once the esophageal ulcer is proven (grade 3), it should be closely followed up using endoscopy.

One hundred sixty-three patients with previously untreated stage I/II non-Hodgkin's lymphoma were analyzed as to their in-field and marginal relapse of the irradiated field following treatment with more than 30 Gy of radiotherapy between 1981 and 1995 at Hyogo Medical Center for Adults. Local regrowth in case of partial response was counted as in-field relapse. Complete response was obtained in 94.5% of the cases at the termination of radiotherapy and in 98.8% finally. The ten-year cumulative in-field relapse and marginal relapse rates were 5% and 8.7%, respectively. The cumulative in-field relapse rate (CIFRR) in cases of bulky disease (more than 5 cm in largest diameter of the tumor) was significantly higher than in those of non-bulky disease (26.1% in 8 years vs 2.4% in 10 years, P < 0.01). The radiation dosage delivered (40 Gy = < and 50 Gy > vs 50 Gy < =) a great much difference in cases of bulky disease (23.8% for 8-year CIFRR vs 0% for 1-year CIFRR, respectively), but less difference with non-bulky disease (2.6% vs 2.2%). High LDH and suboptimal dose chemotherapy (three courses and less chemotherapy containing ADM or its derivatives, chemotherapy without ADM or no chemotherapy) had a negative impact on marginal control in aggressive lymphoma. Extended field setting in aggressive lymphoma was not proven to be beneficial in comparison with involved field setting as to marginal field relapse. Thus, it is concluded that (1) higher doses should be given to bulky disease, (2) careful field coverage with enough margin is recommended for aggressive lymphoma with high LDH or treated without optimal dose chemotherapy, and (3) extended field setting is not necessary.

One hundred three patients with adenocarcinoma of the uterine cervix treated with radiotherapy between 1975 and 1992 were evaluated. The results for 24 patients treated with radiotherapy alone were as follows: The overall 5-year survival rates for Stages I + II (N = 12) and III + IV (N = 12) were 52% and 16%, respectively, lower than those for squamous cell carcinoma (stage I: 89%, II: 54%, III: 44%, IV: 19%). The overall response rate was 79.1%, and the recurrence rate was 54.2% (local recurrence: 29.2%, distant metastasis: 33.3%). In Stage I + II patients with an intracavitary irradiation dose of 40 Gy (LDR) or more, there was no local recurrence. In stage III + IV patients, local recurrence was recognized in spite of the high dosage of intracavitary irradiation. The results for 79 patients treated with combined irradiation and operation were as follows: The overall 5-year survival rates for Stages I, II, III and IV were 76%, 60%, 57%, and 0%, respectively. The incidence of lymph node metastasis was 30.4%, and for Stages I, II, III and IV was 26.7%, 34.6%, 28.6%, and 100%, respectively. This showed that adenocarcinoma had a higher incidence of lymph node metastasis after the early stage. The recurrence rate for patients with lymph node metastasis was 75.0%, significantly higher than 25.4% for patients without lymph node metastasis (p < 0.001). To improve prognosis, 40 Gy or more of intracavitary irradiation dose (LDR) and systemic chemotherapy to prevent distant metastasis are recommended for stage I and II cases. For stage III and IV cases, it was thought to be difficult to control local disease with radiation alone. Additional treatment should be used for these cases, i.e. intraarterial infusion, chemotherapy, hyperthermia and so on.

Purpose: To evaluate the role of radiation therapy for adrenal metastases., Materials and Methods: Fourteen patients, 13 with primary lung carcinoma and one with primary unknown carcinoma, received radiation therapy for adrenal metastases from 1984 to 1995 at the Hyogo Medical Center for Adults. Total dose ranged from 16 Gy to 60 Gy, and fractional dose from 1.6 Gy/ Fr to 3 Gy/Fr., Results: Partial response of the local tumor was recognized in 2 of 7 patients by CT imaging. Pain relief was obtained in 7 of 8 patients. Median survival was 3 months, and 6-month survival was 28.6% in all patients. Among patients in the symptomatic group, who had complaints of pain due to adrenal mass, survival was even worse (12.5% at 6 months). There were no severe complications, but 4 patients (29%) had gastrointestinal symptoms., Conclusion: Radiation therapy is useful for the purpose of pain relief in adrenal metastases.

1. The cytochrome P450 isozymes involved in the deamination of amphetamine (AP) and benzphetamine (BZP) have been studied in liver microsomes from rabbit and rat using isozyme-specific inhibitors. 2. Metabolism of BZP in rat yielding phenylacetone and formaldehyde was moderately inhibited by testosterone and chloramphenicol. N-Debenzylation was thought to be P450-dependent, but all inhibitors except for a non-specific inhibitor, SKF-525A, failed to inhibit this reaction. 3. In rabbit, quinidine and testosterone were potent inhibitors of both BZP deamination and dealkylation. Deamination of AP in rabbit was extensively inhibited only with quinidine. 4. AP deamination with purified rabbit CYP2C3, which was previously identified as the major isozyme responsible for this metabolism, was extensively inhibited with quinidine, previously thought to be a specific inhibitor of CYP2D. 5. These results strongly support the notion that the CYP2C isozymes play a major role in the deamination of both AP and BZP, but not for N-debenzylation of BZP in rat. However, on the basis of different sensitivities toward inhibitors, multiple isozymes seem to be involved in BZP deaminations in both species.

Deamination or oxidative cleavage of the carbon-nitrogen bond in various phenylisopropylamines was examined in liver microsomes from rabbits and rats, and in reconstituted systems containing CYP2C subfamily isozymes. Kinetic studies of phenylacetone formation from six amphetamine (AP) derivatives, catalyzed by rabbit liver microsomes, indicated that AP had the highest apparent affinity (lowest K(m)) and increasing the size of the substituent on the nitrogen atom decreased the affinity. The values of maximal velocity increased with increasing size of the substituent. Experiments with purified CYP2C3 from rabbit liver gave similar results: this enzyme showed the highest activity for phenylacetone formation from benzphetamine (BZP) and showed lower activities with compounds having smaller nitrogen substituents. Based on these results, we conclude that among a series of AP derivatives, the parent phenylisopropylamine has the highest affinity for rabbit liver deaminase, where as BZP has the highest turnover. However, the intrinsic clearance (Vmax/K(m)) values for the individual reactions tended to be comparable. The rates of BZP and deprenyl N-demethylation by rat CYP2C11 and 2C13 were far greater than those of the reactions at other N-alpha-positions. This result indicated that rat CYP2C enzymes have a more rigid regioselectivity than rabbit CYP2C3 for the deamination/N-dealkylation of phenylisopropylamines.

From January 1984 to December 1993, 184 patients with previously untreated T1 and T2 (UICC 1987) laryngeal glottic cancer underwent radiotherapy at Hyogo Medical Center for Adults. The prognostic variables analyzed included sex, age, smoking index, T stage, tumor size, tumor type, gross anterior commissure involvement (gross ACI), histological differentiation, administered dose, TDF, overall treatment time, chemotherapy, initial response, and the dose required to achieve CR. Both univariate and multivariate analyses were performed. The T stage, tumor size, and gross ACI were significant variables in univariate analysis, while the tumor type and gross ACI were significant on multivariate analysis. The 5-year recurrence-free survival of patients with gross ACI was significantly worse than that of those without ACI (57.6% vs. 89.9%). Among gross ACI patients, the recurrence-free survival of those treated with 70-72 Gy was superior to that of those receiving 60-62 Gy, suggesting that at least 70 Gy was necessary to control such diseases.

The results of radiotherapy combined with hyperbaric oxygen in 9 patients with malignant glioma were compared with those of radiotherapy without hyperbaric O2 in 12 patients. This is the first report of a pilot study of irradiation immediately after exposure to hyperbaric O2 in humans. All patients receiving this treatment showed more than 50% regression of the tumor, and in 4 of them, the tumors disappeared completely. Only 4 out of 12 patients without hyperbaric O2 showed decreases in tumor size, and all 12 patients died within 36 months. So far, this new regimen seems to be a useful form of radiotherapy for malignant gliomas.

Thirty-four patients with carcinoma of the vagina were treated by radiotherapy at the Hyogo Medical Center for Adults between April 1965 and May 1990. All patients were treated with a combination of external and intracavitary or intestinal irradiation. Twenty-three patients had squamous cell carcinoma, five had adenocarcinoma and two had malignant melanoma. The five-year survival of patients with squamous cell carcinoma was 70% in Stage I (10 patients), 40% in Stage II (seven patients), 50% in Stage III (three patients) and 0% in Stage IV (three patients). Local control was achieved in 72.7% of the patients with squamous cell carcinoma and 60% of those with adenocarcinoma. However, neither of the malignant melanomas was controlled. Five patients had severe complications that required surgical treatment: severe proctitis and small-bowel perforation, ileus, rectal stenosis, vesicovaginal fistula and small-bowel perforation. Local and pelvic failure was noted in three patients. Patients with previous hysterectomy were more likely to develop serious treatment-related complications.

Ice-embedded crystals of bacteriophage T4 DNA helix-destabilizing protein gp32*I were imaged by computer-controlled spot-scanning on a 400-kV electron cryomicroscope. gp32*I crystals generally have different steps of thickness within a crystal; each step can have different symmetry. Multivariate statistical analysis enabled us to unambiguously select spot-scan images that consist entirely of one motif which were processed subsequently by crystallographic Fourier-averaging techniques. The computed phases of the resulting reflections were evaluated for symmetry in projection, and some of those images were correlated with independent thickness measurements of freeze-dried samples of the same crystals. The structure factors with pgg symmetry from nine spot-scan images were merged, and the mean figure of merit of merged phases was better than 0.9 for data at resolution up to 4 A. A projection map was generated and showed multiple density peaks that corresponded to the high-resolution features of gp32*I.

Gd-enhanced MR images of two patients with clinically and histopathologically diagnosed chronic progressive radiation myelitis (CPRM) were observed chronologically. One of them had had nasopharyngeal cancer and received radiotherapy at a dose of 100 Gy to the C1-2 level of the spinal cord. She developed CPRM 25 months after the termination of radiotherapy. The other had had malignant lymphoma originating from the tonsil and received chemoradiotherapy. The dose delivered to her cervical spinal cord was 40 Gy, and she developed CPRM 30 months later. Gd-enhanced MRI in the early phase revealed a small crescent-shaped nidus with or without a very small central nonenhanced area in both cases. Enhancement was not great. At that time, patients noticed only the inability to perceive pain and temperature or paresthsia in the opposite side. In a few months, MRI revealed a much more strongly enhanced and larger nidus with enlargement of a central nonenhanced area accompanied by long segmental cord enlargement. The patients' neurological symptoms had also progressed, with hemiparesis developing, for example.

Hypertrophic cranial pachymeningitis is uncommon. We report the first case of pachymeningitis extending to the cerebral parenchyma (pachymeningoencephalitis) and involving the bone and extracranial soft tissue. The clinical features and pathogenesis are discussed.

Fifteen patients who had primary vulvar cancer treated with radiotherapy as an initial treatment at Hyogo Medical Center for Adults and Hyogo Cancer Center from January 1971 to December 1990 are presented. Two patients were stage 0, one stage I, three stage II and nine stage III. Nine patients received electron irradiation with or without interstitial irradiation and intracavitary vaginal irradiation. Five patients received megavoltage X-ray irradiation using AP/PA parallel opposed fields including the pelvic nodes and perineum followed by boost irradiation of electrons, interstitial irradiation and intracavitary vaginal irradiation. The total dose delivered to the primary tumor ranged from 50 to 100 Gy (73 Gy on average). The actuarial 5-year survival rate of the patients was 43.6%. Complete regression (CR) was achieved in 60% of the patients. However, CR was not achieved in any of five patients with palpable inguinal nodes. In contrast, all the patients who had tumors of less than 2 cm in diameter achieved CR. Five of nine CR cases relapsed. First sites of failure were vagina, groin and vulvar region. Recurrence occurred more than four years after treatment in three cases. Necrosis occurred in five of nine CR cases.

Despite the effectiveness of the intracavitary irradiation as the boost therapy for the esophageal cancer, the side effect of the normal part of the esophagus has not been studied enough. The purpose of this study is to investigate the histopathological responses of the rabbit esophagus to the high-dose-rate intracavitary irradiation. Esophageal ulcer was observed in the specimen received a dose of 15 Gy during 7 to 28 days after irradiation. Before the mucosal changes were observed, edema and cell infiltration were found in lamina propria. Chronic injury such as necrosis and degeneration of epithelium, and degeneration of the wall of blood vessels was seen at 6 months. No marked changes were found in the specimen received doses of 5 and 10 Gy. The influences of administration of mucosal protection agent and cancer chemotherapeutic drug were also studied. Administration of mucosal protection agent protected the occurrence of severe ulcer and accelerated the recovery from mucosal damage. Administration of cancer chemotherapeutic agent enhanced the radiation injury by the intracavitary irradiation of the esophagus. In conclusion, it was strongly suggested that a single dose of the high-dose-rate intracavitary irradiation should be reduced less than 10 Gy to prevent the esophagus from severe injury.

A human bladder cancer cell line resistant to doxorubicin, KK47/ADM has been established in vitro by exposing KK47 parent cells to progressively higher concentrations of the drug over a period of 16 months. The KK47/ADM was 271 times more resistant to doxorubicin than the KK47 parent. The KK47/ADM exhibited cross-resistance to doxorubicin derivatives (pirarubicin, epirubicin), vinca alkaloids (vinblastine, vincristine) and etoposide, but not to cisplatin, carboplatin, mitomycin C, peplomycin and methotrexate. Unlike the KK47 parent, about 70% of the KK47/ADM cells showed a positive reaction with monoclonal antibody against P-glycoprotein, MRK16. Uptake and efflux studies with [14C]doxorubicin indicated that the resistance exhibited by the KK47/ADM line was mainly due to a lower accumulation of the drug caused by an increased active efflux, and these were reversed in the presence of verapamil. Although verapamil enhanced doxorubicin sensitivity of KK47/ADM, a complete overcoming of the resistance could not be obtained. These two lines with different chemosensitivity are thus considered to be a useful model for developing new chemotherapeutic strategies against multidrug resistant bladder cancer.

A series of 455 bilateral carotid angiographies included 14 accessory middle cerebral arteries (Acc-MCAs) and seven duplication of middle cerebral arteries (Dup-MCAs). The branching patterns of Dup-MCA could be classified as "direct bifurcation" from the internal carotid artery, since most lacked the essential bifurcation or trifurcation at the distal end of the M1 portion. On the other hand, Acc-MCAs are probably residual congenital arteries. These anomalous MCAs were apparently associated with epilepsy. Five Acc-MCAs were associated with anterior communicating artery aneurysm at the origin. In addition, a rare case of Dup-MCA with arteriovenous malformation at its origin was found.

Stereotactic radiosurgery with linear accelerator requires accurate localization of target and accurate spatial delivery of radiation. In phantom study, geometric accuracy of radiosurgery was assessed in combination of CT simulation system (CTSS), which had been developed in our institute, and linear accelerator with supplemental collimator. After determination of target and its isocenter with CTSS, phantom was placed on treatment table so that isocenter meet at the intersection of mechanical axes (gantry, turn table). Displacement of the isocenter from the center of the radiation field was 1 mm in average. It was concluded that this combination could be applied to radiosurgery.

Rat defensins were purified and tested for in vitro bactericidal assay against gram-positive and gram-negative bacteria. Staphylococcus aureus (209P, Cowan I, Smith diffuse and Smith compact) were resistant to defensins, whereas Staphylococcus epidermidis, Staphylococcus saprophyticus, Micrococcus lysodeikticus and Bacillus subtilis were less sensitive. Gram-negative bacteria, such as Pseudomonas aeruginosa (mucoid and K) and Klebsiella pneumoniae (Chedid, 277, and 8N3 which were heavily capsulated, moderately capsulated and noncapsulated, respectively) were all very sensitive to defensins and killed within 20 min. Escherichia coli was moderately sensitive and the rough mutants of lipopolysaccharide (LPS) of Salmonella typhimurium LT2, such as Ra, Rc, Rd, and Re were equally sensitive to defensins, being killed within 40 min. Lysozyme did not show any bactericidal activity except against M. lysodeikticus and B. subtilis, whereas it enhanced the bactericidal activity of defensins against P. aeruginosa, E. coli, and K. pneumoniae and suppressed the killing activity of defensins against S. typhimurium and S. aureus. With regard to the three synthetic rabbit defensins, NP1, NP4, and NP5, NP1 showed strong bactericidal activity against K. pneumoniae 277, comparable to that of rat defensins. Neither NP4 nor NP5 showed any bactericidal activity, while NP5 rather enhanced the bactericidal activity of NP1 against K. pneumoniae 277.

Cytologic studies in patients with prostatic infection, primarily those with chronic prostatitis, were conducted on samples obtained by the fine needle aspiration method. Infiltration of inflammatory cells such as polymorphonuclear leukocytes and macrophages was observed to a greater extent in patients with chronic bacterial prostatitis as compared to those with chronic nonbacterial prostatitis or prostatodynia. The pathogen was isolated in only one out of 28 patients with chronic bacterial prostatitis. We concluded that fine needle biopsy is useful for assessing patients with prostatic inflammation, but not for detecting microorganisms because of focal colonization of the organisms in the glands.

We have reported the isolation and characterization of three factor-dependent macrophage cell lines from bone marrow cells of C3H/HeN mice. We have since isolated a subclone, BDM-1W3, from one of these cell lines. We found previously that BDM-1W3 has a different sensitivity to bacterial lipopolysaccharide (LPS) for growth than its parental cell line, BDM-1. In this report, we show that LPS inhibits BDM-1W3 phagocytosis of antibody-coated sheep erythrocytes (Fc-mediated phagocytosis), whereas it enhanced Fc-mediated phagocytosis by BDM-1. It was observed that a loss of Fc-receptor capacity parallels a loss of phagocytic activity in LPS-treated BDM-1W3 cells. LPS stimulated phagocytosis of latex beads by BDM-1 and BDM-1W3, suggesting that Fc-mediated phagocytosis and phagocytosis of latex beads differ in their regulatory mechanisms. When BDM-1 cells were cultured with LPS, they underwent drastic morphological changes, whereas LPS-treated BDM-1W3 cells did not change significantly. Gamma interferon enhanced FC-mediated phagocytosis by BDM-1, while it has no significant effect on that by BDM-1W3. These cell lines should be useful for studying signal transduction mechanisms in LPS-mediated macrophage activation.

The histopathological responses of the rabbit esophagus to high-dose-rate intracavitary irradiation were investigated. After 5, 10 or 15 Gy irradiation using a remote afterloading system, the rabbits were sacrificed on different occasions. The esophagus was excised from each animal and examined histopathologically. Esophageal ulcer was observed 7 to 28 days after the irradiation of the highest dose. Edema and cell infiltration in the lamina propria proceeded mucosal changes like ulcer. Chronic injuries such as mucosal necrosis were seen at 6 months.

A case of arteriovenous malformation (AVM) associated with a meningioma is reported. A 28-year-old woman was hospitalized for generalized convulsion. CT scan and right carotid angiogram revealed AVM in the right parietal lobe extending to the wall of the lateral ventricle. At the time of surgery an intraventricular meningioma attached to the choroid plexus was found in the excised cavity of the AVM. It is suggested that the meningioma might have been caused by chronic irritation due to an increased blood flow in the arteries supplying the AVM, because the AVM and the meningioma exist in the same lesion and share the same blood supply.

We reviewed 57 cases of Stage IV renal cell carcinoma to clarify the factors influencing prognosis and to evaluate the value of nephrectomy. Cumulative survival from the initial diagnosis was analyzed with respect to the patients' age, sex, side of primary tumor, initial performance status (PS), site of metastasis, and nephrectomy. Overall survival for the patients was 51 percent at one year, 22 percent at three years, and 11 percent at five years. Age, sex, and side of primary tumor had no influence on survival. Improved survival was correlated with good PS, metastases limited to single organ, and removal of the primary tumor. With regard to histopathologic features in nephrectomized patients, low grade and stage were correlated with longer survival. These factors should be considered in the analysis of results of future clinical trials of metastatic renal cell carcinoma.

Forty-six lung cancer patients received radiotherapy from 1982 to 1987 were reviewed to analyze the incidence of radiation pneumonitis and the factors which were related to it. The incidence of which evaluated with plain chest X-ray was 54% at 1 month, 78% at 3 months and 89% at 6 months after radiotherapy. The relationship between severity of pneumonitis and several parameters were studied. As a result, six parameters consisting of pre-radiotherapy granulocyte counts, tumor location, T-factor, radiation dose, radiation field size and the combination timing of chemotherapy were found to be contributing factors.

A percutaneously inserted biliary drainage catheter was converted from external to internal drainage with the use of an additional catheter advanced through the gastrostomy opening. This technique was successful in one patient with unresectable cancer of the head of the pancreas, in whom it was performed to overcome the various disadvantages of external biliary drainage.

We report a rare case of ectasia of both pericallosal arteries in a non-hypertensive 37-year-old female, whose internal carotid arteries and vertebrobasilar arteries were normal. The computed tomography (CT) showed irregular calcifications in the midline in the frontal region extending to the corpus callosum, which became partially enhanced along the course of the pericallosal artery following intravenous contrast administration. The diagnosis of arterial ectasia was established by angiography.

Molecular size heterogeneity of immunoreactive prolactin (PRL) in sera of pregnant women and patients with PRL-secreting pituitary tumor as well as pituitary tumor extract was investigated. "Big big PRL" in the vicinity of the void volume was identified by PRL radioimmunoassay. The ratio of "big big PRL" to "little PRL" was almost constant in normal pregnant women, while the proportion varied from case to case in patients with pituitary tumor. The ratio of "big big PRL" to "little PRL" was significantly (P less than 0.01) larger in these patients (43.3 +/- 9.8%, mean +/- SE) than in pregnant women (13.0 +/- 0.77%). Neither radiation therapy nor thyrotropin releasing hormone (TRH) stimulation significantly affected the ratio of "big big PRL" to "little PRL", while it decreased from 20.5% to 9.5% one month after tumor resection. The elution patterns of the normal human pituitary extract and the tumor extract obtained from patients with PRL-secreting pituitary tumor revealed peaks in identical positions, although the ratio of "big big PRL" to "little PRL" in the tumor extract (38.2 +/- 3.6%) was significantly (P less than 0.01) larger than that in normal human pituitary extract (5.8 +/- 2.8%). These results indicate that "big big PRL" is present in sera of pregnant women and patients with PRL-secreting pituitary tumor, normal pituitary extract and tumor extract. It is also suggested that the increased circulating "big big PRL" observed in patients with PRL-secreting tumor may originate in tumor tissue.

We have established an anti-sense RNA system which is capable of regulating expression of the class II (Ia) molecule coded for by the major histocompatibility complex in cultured mouse cells. Various areas of the I-A beta chain gene were subcloned in an anti-sense orientation to the 3' of the dihydrofolate reductase (DHFR) cDNA under the control of the human metallothionein IIa gene promoter. These anti-sense DNA constructs were transfected into M12.4 cells, a BALB/c B lymphoma cell line which expresses both I-A and I-E molecules on the cell surface. I-A expression of selected clones transfected with anti-sense DNA encompassing the 5' untranslated region (UT) (100 or 310 bp) including the translation start site or the poly(A) addition signalling sequence in the 3' UT (250 bp) of the I-A beta chain gene were specifically reduced to less than 5% of the control M12.4 cell surface I-A expression. These clones had normal levels of I-E expression. However, transfection of the anti-sense DNA to the beta 1 domain (510 bp) including the splicing donor and acceptor sequences did not affect the expression of I-A molecules. The same antisense DNA constructs (100 bp of the 5' UT or 250 bp of the 3' UT) without the DHFR cDNA (710 bp) did not down-regulate the expression of I-A molecules, indicating that either the physical length of the anti-sense RNA or specific DHFR cDNA sequences are also important.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of intravenous infusion of 10% glycerol on polymorphic delta waves of EEG was investigated in 13 patients (15 studies) with brain tumors in cerebral hemisphere. The delta waves were analyzed by two-dimensional EEG topography and power spectrum of delta waves (P(delta)) over the tumor, adjacent, and distant regions in the same hemisphere to the tumor, and ipsi- and contralateral hemispheres to the tumor. The data focus of EEG topography was well corresponded to the tumor and surrounding brain edema which visualized by x-ray CT-scan. In the patient with brain tumors with marked brain edema (group A, 11 studies), EEG topography showed marked reduction of delta focus within 20 minutes from the end of intravenous infusion of glycerol, and returned to preinfusion distribution within 60 minutes. In patients with absent to minimum brain edema (group B, 4 studies), delta focus showed the tendency to enlarge and returned to preinfusion state at 60 minutes after the end of glycerol infusion. In patients of group A, P(delta) of ipsilateral hemisphere to tumor decreased at the end of glycerol infusion, and showing maximal reduction ratio (30%, p less than 0.01) at 20 minutes, re-increased there-after. In group B, P(delta) of ipsilateral hemisphere showed no definite changes after the glycerol infusion. P(delta) of contralateral hemispheres in patients of both group A and B, showed similar reduction ratio and time course to those of ipsilateral hemisphere of group A.(ABSTRACT TRUNCATED AT 250 WORDS)

CT findings of 6 cases with germinoma originating in the basal ganglia and thalamus are reported. The early finding of germinoma in this region on plain CT, was an irregularly defined, slightly high density area without mass effect. Repeated CT scanning showed enlarging iso-density lesion accompanied by mass effect to high. Intratumoral cysts and calcifications were frequently observed. The tumor showed mild to moderate and inhomogeneous enhancement by intravenous injection of contrast medium. A tendency to ipsilateral hemicerebral atrophy was found in one case. These findings were somewhat different from those of germinomas in the pineal and suprasellar regions. This phenomenon may be related to the anatomical difference of the brain where the tumor originated.

A case of asymptomatic syringomyelia associated with tentorial meningioma is reported. A 53-year-old female was admitted to our hospital with the complaints of headache, decrease of bilateral visual acuity and gait disturbance. Neurological examination revealed no abnormality except for bilateral papilledema and left cerebellar sign. Motor and sensory systems were also intact. CT and MRI scans showed a left tentorial mass lesion, cervical syringomyelia and left tonsillar herniation. A relationship between the fourth ventricle and syringomyelia was not clearly identified. The tumor was totally removed and a histological diagnosis of fibroblastic meningioma was made. Postoperative radiological examination showed a diminishing of syringomyelia with the improved tonsillar herniation. Association of syringomyelia with brain tumor was reviewed, and its pathogenesis was discussed.

A mutation in the tolC(mtcB) gene of Escherichia coli K12 results in increased sensitivity to sodium dodecylsulfate (SDS), sodium deoxycholate, basic dyes, mitomycin C, and bleomycin, and makes the cell tolerant to the killing action of colicin E1. From lysogens with lambda cI857S7 integrated at a secondary attachment site, a transducing phage (lambda dtolC+) that transduces a tolC recipient to SDS resistance was isolated. A recombinant DNA molecule was constructed in vitro from plasmid pBR322 as a vector, and an EcoRI-BamHI fragment of lambda tolC+ DNA. The resulting plasmid, designated pOK1, was 5.6 megadaltons (Md). The tolC bacteria transformed with plasmid pOK1 restored the TolC+ phenotype with regard to mitomycin C, SDS, and colicin E1 sensitivities. A plasmid with an amber mutation in the tolC gene, designated pOK18, was isolated by the same procedure used for the isolation of pOK1. The plasmid had a molecular weight of 5.6 Md and produced the same size of DNA fragments as the tolC+ plasmid, pOK1, after digestion with the indicated restriction enzymes. The plasmid, pOK18, conferred the TolC+ phenotype when introduced into a tolC strain in the presence of, but not the absence of, an amber suppressor. Plasmid-specified polypeptides were determined by using maxicells of strains uvrA recAsup+ and uvrA recA tyrT, containing each plasmid. Three additional proteins of 54,000 (54K), 29K, and 27K were produced in maxicells containing pOK1. These three proteins were synthesized in maxicells of the uvrA recA tyrT strain carrying pOK18, whereas synthesis of the 54K protein by pOK18 did not take place in maxicells of the uvrA recA sup+ strain, although the other two proteins were produced in normal amounts. From these results we concluded that the product of the tolC gene is a protein with a molecular weight of 54K.

Two cases of sinus pericranii are reported. X-ray films, taken with the direct injection of contrast medium into the extracranial blood cavity, made visualization of the intracranial venous systems possible in both cases. The pericranial blood sinuses were totally removed and communications through the osseous holes were closed with bone wax. The pericranial blood sinuses, surrounded by connective tissues, were located mainly in the subgaleal and supraperiosteal space. The literature is reviewed.

We have studied the prognostic factors of 117 cases of unresected adenocarcinoma of the lung, and have examined these cases according to the following categories: age, sex, clinical stage, performance status (P.S.), serum albumin on admission, serum CEA, the presence of complication, the present status of an abnormal chest shadow from a year ago at the same location, and differentiation of cells. Significant differences were detected in the P.S., the serum albumin and the presence of complications by survival analysis through the use of covariate-Cox models. We also have noted that the difference between stage I and the other stages of the clinical stage was found to be significant by a generalized Wilcoxon test. In conclusion, the determining prognostic factors of an unresected adenocarcinoma of the lung are the P.S., the serum albumin, the presence of complications and the clinical stage.

The authors report a case of an angiographically occult arteriovenous malformation (AVM) that showed a marked increase in size over a period of 7 years. The importance of accurate diagnosis, follow-up computed tomography and repeated angiography, if needed, is stressed in cases where enlargement of an occult AVM is suspected.

Acquisition of repertoires and genetic restriction specificities of suppressor T cells (Ts) and their factors were studied by using full allogeneic radiation bone marrow chimera and H-2 congenic pairs, B10.A(3R) and B10.A(5R), which received conventional or cloned macrophages by cell transfer. Suppressor T-cell factor (TsF) from C3H----C57BL/6 or C57BL/6----C3H chimera suppressed only donor but not host-type responses of either C3H or C57BL/6, in an antigen-specific fashion. However, if chimera mice were given conventional or cloned macrophages of the host type, the chimera TsF in turn suppressed both the responses of C3H and C57BL/6 mice but not those of the third party, BALB/c, indicating that macrophages are responsible for the acquisition of host restriction specificity. Similarly, B10.A(5R) mice developed I-Jb restricted Ts or TsF when the B10.A(3R) macrophage cell line was injected at the time of antigen priming. The reverse was also true. B10.A(3R) mice did generate I-Jk restricted Ts when they received the B10.A(5R) macrophage cell line. Thus, the results clearly demonstrated that B10.A(3R) or B10.A(5R) mice potentially possessed their ability to express both I-Jk and I-Jb determinants and that repertoires and genetic restriction specificity of Ts and their TsF were acquired at a macrophage level at the time of antigen-priming.

Bladder pressure changes in the completely physiological state of dogs were recorded on voiding, coughing, defaecating, vomiting, etc, by a pressure transducer embedded in the submucosal layer of the anterior bladder wall. The static pressures in the standing and lying positions were almost the same at about 10 cm H2O and in the sitting position the pressures were about 30 cm H2O. The voiding pressure was recorded 28 times and ranged from 44 to 257 cm H2O (average 141). These data were higher than expected and we recommend further studies on the maximum voiding pressure. On voiding, various patterns of pressure curve were observed and in the monophasic pressure curve, which probably shows normal urination, there was a time difference between urine flow and voiding pressure curve. Our new method may be useful not only as a sensory device for neurogenic bladder patients but also as an experimental system to study the effect of drugs on autonomic nerves.

Three cases of trigeminal neurinoma originating from the Gasserian ganglion were reported. The findings observed on plain roentgenograms, cerebral angiograms and pneumoencephalograms were described in detail. Neuroradiologic examinations used routinely our department for the diagnosis of the skull base tumors were as follows; (1) plain skull examinations, including lateral, straight posterior-anterior, anterior-posterior half axial (Towne), axial, Stenvers, optic canal as well as tomograms in frontal, sagittal and axial projections; (2) angiographies by transfemoral catheter technique including selective internal carotid, external carotid and vertebral angiograms, and orbital-cavernous sinus venography via frontal and femoral veins; (3) pneumoencephalography with tomography. Bone destruction of the middle fossa including foramen ovale, foraman spinosum and lateral aspect of the sella was seen in all cases. Superior orbital fissure, optic canal and anterior surface of the petrous bone were also eroded depending upon the extent of tumors. Sharply circumscribed erosion of the petrous apex was seen in one of 3 cases, indicating the tumor extention into the posterior fossa. A soft tissue mass in the sphenoid sinus and ethmoidal air cells was recognized in all cases. Selective internal and external carotid angiograms demonstrated tumor vessels in 2 of 3 cases. Orbital-cavernous sinus venography was helpful for the interpretation of the lesion extending to the cavernous sinus and its neighboring structures. Conventional gas encephalography showed elevation of the temporal horn, and the concave arch formed by the supracornual cleft and lateral cleft was directed basally and medially in all of the cases. Tomography was also useful in the more detailed analysis of temporal horn. It should be stressed that the plain skull features are most important for deciding which contrast examination should be performed further.

A mixed colloid cyst-xanthogranuloma of the third ventricle is described. The xanthogranuloma associated with the cyst completely occupied the third ventricle. On light microscopy, a single epithelial layer with a basal lamina was seen lining the cyst wall. Electron microscopic study revealed three different kinds of cells in the epithelial layer: ciliated, nonciliated, and basal cells. Many lipid droplets were present in the superficial epithelial cells, macrophages, pericytes, and endothelia. The pathogeneses of the cyst and of the xanthogranuloma are discussed.

In 47 cases with intracranial lesions, auditory brainstem responses (ABRS) were studied. From a detailed analysis of these data, the following results were concluded: In some cases, the intramedullary and extramedullary pontine tumor could be differentiated by ABR, A very small cerebello-pontine angle tumor was detected by ABR, ABR monitering was useful to evaluate brainstem function during the surgical operation, and ABRS were clinically very useful methods for predicting the outcome of a severe head injury and diagnosis of brain death. These results indicate that ABRS contribute to functional diagnosis of various diseases of the central nervous system.