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Evaluation of the clinical and pathological factors associated with the treatment and outcomes of external auditory canal (EAC) carcinomas.A retrospective review of clinical and pathological analysis was performed on 23 patients who were histologically diagnosed with EAC carcinomas and treated at Hamamatsu University hospital. We evaluated the clinical staging, treatment methods, pathological diagnosis (particularly squamous cell carcinoma, SCC), and patient outcomes. Main outcome measures include staging, treatment procedures, pathological features, and estimated survival rates.The 5-year overall survival (OS) of study participants was 75.2% and the 10-year OS was 60.2% using the Kaplan-Meier method. The prognosis for SCC was poor compared with other carcinomas (p= 0.0462). The prognoses for SCC patients after treatment with surgery alone and after postoperative radiotherapy or chemoradiotherapy were significantly better than for patients with unresectable tumours (p = 0.0004 and p = 0.0001, respectively). There was no significant difference among the four tumour stage groups. Information about patients' survival status was obtained after a median follow-up period of 57.5 months (range, 7-151 months).Our survival analysis data for carcinoma of the EAC demonstrates that SCC and unresectable cases are associated with poor outcomes. Outcomes for patients with operable disease more closely parallel the survival curves of patients with advanced stage T4 disease. Patients with SCC should be strictly categorized as cases with severe disease.

Prognostic factors of juvenile myelomonocytic leukemia (JMML) have not been clarified because of its very low incidence and inaccuracy in the diagnosis. The purpose of this study was to evaluate children with JMML given an allogeneic hematopoietic stem cell transplantation (SCT) and the role of different variables potentially influencing outcome in a nationwide survey in Japan based on the newly proposed criteria by the International JMML Working Group. The study patients were 27 children who underwent SCT among 55 JMML patients retrospectively collected in the survey. The source of grafts was HLA-identical siblings in 12 cases, HLA-matched unrelated individuals in 10 and others in five. Total body irradiation was used in 18 cases. Event-free and overall survival (OS) at 4 years after SCT were 54.2 +/- 11.2% (s.e.) and 57.9 +/- 11.0% (s.e.), respectively. Six patients died of relapse and three of complications. Patients with abnormal karyotypes showed a significantly lower OS than those with normal karyotypes (P0.001). Patients below 1 year of age showed a significantly higher OS than those of 1 year of age or more (P = 0.02). Patients with grade 0-1 acute graft-versus-host disease (GVHD) or chronic GVHD had a more favorable OS than those without them, although they were not statistically significant (P0.05). Other variables studied were not associated with OS. A multivariate analysis of these factors yielded the abnormal karyotype as the only significant risk factor for lower OS (risk ratio: 11.0; 95% CI: 2.7-45.1).

Developers used in photolithography contain toxic tetramethylammoniumhydroxide (TMAH) and this creates a problem of how to properly treat developer wastewater. We have developed a TMAH wastewater treatment technique that consists of a combination of two novel decomposition processes: pyrolyzing TMAH to TMA and decomposing TMA to N/sub 2/, H/sub 2/O, and CO/sub 2/ by means of a selective oxidation catalyst for nitrogenous compounds. We have tested a system using this technique in long-term treatment of the actual wastewater and have found it to be sufficiently practical. The running cost of a treatment system using our technique would be about one-ninth that of disposing of the wastewater as industrial waste but about 2.3 times that of biological treatment. Compared with biological treatment, however, our system is tolerant to many treatment conditions and operation management is much easier. Furthermore, it occupies only about one-sixth the area of a biological treatment system.

Se estudio el efecto del almacenamiento a temperatura y humedad relativa altas (33-35°C, HR = 75%, 160 dias) en las caracteristicas de calidad de tres variedades de garbanzo (Cicer arietinum L) para consumo humano: Surutato 77, Mocorito 88 y Blanco Sinaloa 92. El almacenamiento provoco el desarrollo del fenomeno de endurecimiento, tambien conocido como hard to cook (HTC), en las tres variedades. Para todas las variedades la luminosidad L disminuyo (p

A cantilever used for atomic force microscopy (AFM) is modified by an ultra-thin layer of polymeric gel so that the resulting tip can respond differently depending on the kind of nucleotides present in solution. A cross-linked poly((3-acrylamidopropyl)trimethylammonium-co-(3-acrylamido)phenylboronic acid) is grafted on the surface of ordinary AFM tips by in-situ polymerization. The thickness of a dried polymer layer is determined to be 8 nm. In pure water, the force–distance curves of the gel tip against a hydrophobic surface indicate that the gel layer is swelled. At pH 7 and higher, adenosine 5’-monophosphate (AMP) causes the gel to shrink and a strong adhesion to appear in the force curve whereas 2’-deoxyadenosine 5'monophosphate (dAMP) hardly affects the gel layer other than a slight shrinkage. Lowering pH to 4.8 using acetate buffer brings the once shrunken gel back to a swelled state again. Production of cross-linking points by a cyclic ester linkage between the phenylboronic acid group and the ribose unit of AMP and the electrostatic interaction of the anionic phosphate group of AMP with the cationic ammonium groups as well as neutralization of ionizable groups contributes to shrinkage of the gel layer. Thus, the cis -diol recognition ability of boronic acids is implemented effectively to the nucleotide-responsive AFM tip.

Storage, at high temperature (> or = 25 degrees C) and high relative humidity (> or = 65%), causes development of hard to cook (HTC) phenomenon in grain legumes. The objective of this work was to study the effect of storage simulating tropical conditions on chickpeas quality. The hardening of the Surutato 77, Mocorito 88, and Blanco Sinaloa 92 chickpea varieties was produced using adverse storage (32 +/- 1 degrees C, RH = 75%, 160 days) conditions. For all samples, the Hunter 'L' values decreased and deltaE values increased during storage, meaning a loss of color lightness and development of darkening. Accelerated storage caused a significant decrease in the water absorption capacities and cooking times of whole seeds, cotyledons and seed coats of all samples, being more pronounced in The Blanco Sinaloa 92 variety. Furthermore, storage produced significant decreases in the seed coat tannin content of the three materials; this parameter increased significantly in the cotyledon. In all samples, the levels of phytic acid decreased significantly with the seed hardness. Hardening of chickpea grains caused a decrease in the in vitro protein digestibilities of all varieties. These results suggest that both the cotyledon and seed coat play a significant role in the process of chickpea hardening. Blanco Sinaloa 92 and Mocorito 88 might be classified as varieties with high and low proneness, respectively, to the development of the HTC condition.

最大径3mmのIs型sm大腸癌の1例を経験した.隆起型の微小sm大腸癌は珍しく,大腸癌の自然史を考察するうえで非常に興味深い.症例:46歳,女性.主訴:下痢.便潜血反応陽性で軽度貧血を認めたため精査目的で当科受診.大腸内視鏡検査でS状結腸に径約3mmのIsポリープを認め,内視鏡的粘膜切除術(EMR)を行った.組織診断は高分化腺癌で腺腫成分は認められず,深達度sm,切除断端陽性であった.このため後日腹腔鏡補助下S状結腸切除術,D2郭清を行った.追加切除標本に癌の遺残を認め,深達度はsm3,先進部中分化腺癌,脈管侵襲陽性,n1(1/12)であった.微小sm大腸癌はほとんどが陥凹型であり,自験例のような隆起型は現在まで報告がない.自験例は腺腫成分を持たないことからde novo発癌と考えられ,隆:起型として発育し,ごく早期の段階で粘膜下層に浸潤したと考えられた.

A total of 64 newly diagnosed acute myelogenous leukemia patients (except FAB M3 and/or Down syndrome) under 18 years of age were consecutively enrolled into the study. Patients having an HLA-identical sibling (allo group) were assigned to undergo allogeneic bone marrow transplantation (allo BMT) in the first complete remission (CR). Others (non-allo group) were assigned to undergo autologous peripheral blood stem cell transplantation (PBSCT) or autologous BMT (auto BMT). Conditioning regimen was busulfan + melphalan for all transplantation. Of 64 patients (allo group 24; non-allo group 40), 59 (92.2%) achieved a CR. Eighteen relapses occurred (allo group 4; non-allo group 14) and 6 died during the first CR. The 5-year event-free survival (EFS) rate was 53.3 +/- 6.4% at a median follow-up period of 45 months. The 5-year EFS rates of allo and non-allo groups were 70.8 +/- 9.3% and 43.0 +/- 8.1%, respectively (p = .08). The EFS rates at 5 years post-transplant for allo BMT from an HLA-identical sibling (n = 18), PBSCT (11), and auto BMT (6) were 88.1 +/- 7.9%, 41.6 +/- 19.7%, and 83.3 +/- 15.2%, respectively. The outcome of allo BMT was superior to that of autograft. Auto BMT rather than PBSCT might contribute to a long-term survival in case of no available HLA-identical siblings.

The selective catalytic oxidation (SCO) of ammonia to N 2 was studied by using a series of noble metal-V 2 O 5 -WO 3 catalysts supported on titania-silica (TS) prepared by coprecipitation method. In the V 2 O 5 - WO 3 catalyst system, the use of TS as a support was very effective to enhance catalytic activity compared with TiO 2 or SiO 2 alone. The addition of a slight amount of Pd and Ir to V 2 O 5 -WO 3 /TS catalyst caused also remarkable enhancement of the catalytic activity without decreasing the selectivity to N 2 . The present catalysts provide remarkably high catalytic performance for SCO of ammonia to N 2 under the practical reaction conditions for an industrial application.

8歳女児の原発性肺癌の症例を経験した。発熱, 咳嗽にて発症し, 胸部X線上, 右上葉の肺炎と右中下葉無気肺を認めた。抗生剤治療に抵抗するため気管支鏡にて生検を行い, 低分化型扁平上皮癌, T4N2M0, Stage IIIBと診断した。マイトマイシンC (MMC), ビンデシン (VDS), シスプラチン (CDDP) による化学療法と放射線療法を行った。胸郭内病変は画像上ほぼ消失したが, 骨, 皮膚および肝臓への転移が出現し, 発症後8ヵ月で死亡した。小児の原発性肺癌は極めて稀であり本邦では現在まで28例が報告されているにすぎない。5年以上生存している5症例はStage IまたはIIであり, 全例完全切除術が行われていた。死亡した進行肺癌症例を小細胞癌と非小細胞癌に分けて生存期間について検討したところ, 成人のそれとほぼ同様の結果であった。

A new circuit technique of deserializing for Gb/s serial communication such as "digital visual interface" for PC and "high-definition multimedia interface" for CE application is proposed. Vernier over sampling and alignment technique can achieve both low power and low bit error rate at high frequency operation in DVI/HDCP digital graphic communication receiver. VOSA circuit is simple and mostly digitally controlled, therefore it is robust and portable. Demonstrating VOSA performance, the circuit was implemented to the DVI digital flat panel communication link receiver as an analog front-end (AFE) with the industry standard 0.25mum CMOS process

This paper describes a wide band CDR with a new encoding scheme for a digital video data transmission. The CDR works from 105Mbps to 1365Mbps without any external frequency references. The proposed encoding scheme uses both PECT (periodic embedded clock transition) and PECT (periodic embedded clock period) scheme, and it helps the CDR's capture process. The CDR is using both digital and analog techniques. Digital block adjusts VCO frequency utilizing PECT and PECP scheme, and analog block maintains lock with small jitter. The device is fabricated on 0.35mum standard logic CMOS process

Aim: Adult T-cell leukemia/lymphoma (ATL) is a human T-cell leukemia virus type-1 (HTLV-1)-infected T-cell malignancy with extremely poor prognosis due to frequent relapse. Among HTLV-1 antigens, the viral regulatory protein Tax is widely recognized as a target of cytotoxic T lymphocytes (CTLs). We investigated the safety and feasibility of Tax peptide-pulsed dendritic cell (Tax-DC) vaccine therapy administered to augment Tax-specific CTL responses in ATL patients. Methods: Three previously treated acute-type ATL patients possessing HLA-A*0201, A*2402 and/or A*1101 in stable condition were enrolled in the study. Autologous monocyte-derived dendritic cells (DCs) that exhibited the mature phenotype were pulsed with Tax peptides corresponding to the major epitopes of Tax-specific CTL previously identified from ATL patients who received stem cell transplantation. The vaccine protocol consists of three subcutaneous injections of Tax peptide-pulsed DC at 2-week intervals in a total 8-week observation period to assess adverse events. The primary endpoint of the study was to evaluate safety and feasibility of Tax-DC vaccine. Results: DC vaccine-related toxicities were grade 1 or 2 and were considered relatively mild, and non-hematological toxicity was acceptable. Two patients achieved partial remission and one obtained stable disease. The performance status improved after vaccination in all patients and two of them are currently alive without any additional chemotherapy for 17 and 12 months respectively, while the third patient developed slowly progressive disease, although additional therapy was not required until 14 months after vaccination. In all three patients, the level of HTLV-1 proviral load in the peripheral blood mostly revealed below 100 copies per 1,000 PBMCs during the observation period, and Tax-specific CTL responses were observed with a peak at 16-20 weeks. Conclusions: The good quality of lives and long-term treatment-free survival after vaccination observed in this first pilot study indicates that the Tax-DC vaccine is a safe and promising long-lasting maintenance therapy for ATL. Disclosure: All authors have declared no conflicts of interest.

We have performed intra-hepatic arterial chemotherapy for 9 patients with liver metastasis arising from gastric cancer. We mainly used 5-FU and CDDP as antineoplastic drugs.The median survival after gastrectomy was 600 days. Of 9 cases, 2 showed CR, 4 PR, 2 NC, 1 PD. The response rate was 67%. The 9 cases were classified into 2 groups. One group, the short-term survival group, concised of 5 patients that had no more than 2 years survival and the other, the long-term survival group, consisted 4 patients that had more than 2 years survival. We compared these 2 groups and found no difference in the primary lesions between the 2 groups. The patients in the long-term survival group had fewer and smaller metastatic lesions in the liver than the patients of the short-term survival group. The patients in the long-term survival group had no unresectable lesions except liver metastasis when gastrectomy was performed. However, 2 patients in the short term survival group had unresectable lymphatic involvement at the time gastrectomy was performed. Of 9 patients, 6 died from the extrahepatic lesion.The intra-arterial chemotherapy was effective and useful for liver metastasis arising from gastric cancer. However, the majority of patients died from extrahepatic lesions. We should therefore consider the use of systemic chemotherapy with intra-arterial chemotherapy.

We evaluated the usefulness of the following three in vitro assays in cases of resected colorectal liver metastases. Chemosensitivity by collagen gel droplet drug sensitivity test (CD-DST) was very low in all cases, suggesting this method is not predictive for this disease. In contrast, thymidylate synthetase (TS) activity and dihydropyrimidine dehydrogenase (DPD) activity in tumor tissue were high in many patients with recurrent disease. Thus, these enzyme activities are promising for assessment of clinical outcome following hepatic resection of colorectal liver metastases. Further analyses with large numbers of cases are needed to determine the significance of these in vitro studies.

Malignant tumor resection of the hepatic caudate lobe has recently received attention. However, there are few reports about metastatic liver tumor in the caudate lobe from colorectal carcinoma, and its clinical features still remain unknown. In this paper, three patients operated on in our institute and 15 reported cases from the published literature were analyzed in order to reveal clinical features of this disease. Many cases had advanced liver tumors, such as invasion in to major vessels at the time of operation. Isolated complete caudate lobectomy was performed in 8 patients and major hepatectomy was carried out in 6 instances. Seven cases also underwent partial resection of the inferior vena cava. Recurrence of disease was observed in 11 patients: seven cases had relapse only in the residual liver, five of whom underwent another hepatectomy. The median survival time of those patients who died was 25 months, and that of seven cases with IVC resection, 18 months. Two patients out of five who received a second hepatectomy survived for longer than 90 months. It is suggested that aggressive surgical treatment including repeated hepatectomy results in the prolongation of survival. Earlier diagnosis and surgical treatment at a more appropriate stage of the disease may further improve the survival rate.

A 57-year-old woman underwent distal pancreatectomy for malignant islet cell tumor of the pancreas in 1991. One year later, multiple liver metastases appeared. Although three transcatheter arterial embolizations (TAE) with spongel and nine ethanol injections were performed over seven years, the tumors were growing gradually. Therefore, TAE with degradable starch microspheres (DSM) was selected. Under angiography, TAE of the left hepatic artery was done using 900 mg of DSM following injection of Farumorubicin (20 mg), Lipiodol (3 ml) and cisplatin (90 mg). The tumors in the embolized hepatic area were remarkably decreased in size, and satisfactory local control was obtained. Thereafter, TAE with DSM was carried out twice, and she is still living with outpatient treatment. Thus, it is suggested that TAE with DSM could be a promising, alternative therapeutic modality for liver metastases from malignant islet cell tumor of the pancreas.

We evaluated the significance of hepatectomy following hepatic arterial infusion (HAI) chemotherapy for colorectal liver metastases. The prognosis of 4 cases with initially resectable tumors was discouraging, indicating no benefit of preoperative HAI for resectable tumors. The 2- and 3-year survival of patients who underwent hepatectomy after downstaging by HAI of originally unresectable metastases were 100% and 67%, respectively, suggesting that hepatectomy combined with HAI is a promising modality for those patients. However, it seems that the control of extrahepatic disease and decision making for the timing for surgical therapy are issues requiring improvement.

In recent pediatric collaborative studies of acute myeloid leukemia (AML), patients with Down's syndrome (DS) have better outcome than other patients when they were treated according to their intensive AML protocols. This may be attributed to enhanced sensitivity of DS AML cells to selected chemotherapeutic agents. We evaluated a less intensive chemotherapeutic regimen which was specifically designed for children with AML-DS. Remission induction chemotherapy consisted of daunorubicin (25 mg/m2/day for 2 days), cytosine arabinoside (100 mg/m2/day for 7 days), and etoposide (150 mg/m2/day for 3 days). Patients received one to seven courses of consolidation therapy of the same regimen. Thirty-three patients were enrolled on the study and their clinical, hematologic and immunophenotypic features were analyzed. Of the 33 patients, all were younger than 4 years and diagnosed as having acute megakaryoblastic leukemia or myelodysplastic syndrome. All patients achieved a complete remission and estimated 8 year event-free survival rate was 80+/-7%. Three patients relapsed and two died due to cardiac toxicity and one due to septic shock. The results of our study showed that patients with AML-DS constitute a unique biologic subgroup and should be treated according to a less intensive protocol designed for AML-DS.

Although current chemotherapeutic regimens cure as many as 70% of children with acute lymphoblastic leukemia (ALL), infants continue to show a poor outcome. In this paper, we describe the outcome in 37 ALL infants treated between 1989 and 1995 in Japan. Patients had characteristic findings of infant ALL, including hyperleukocytosis100 x 10(9)/l (15/37, 41%), blast cells with a CD10-negative phenotype (30/37, 81%), and 11q23/MLL involvement (21/37, 57%). Seven were treated according to Aggressive Treatment Research Group protocol, 15 according to the Ministry of Health and Welfare protocol, and 15 according to protocols of other institutions. The 3-year overall event-free survival (EFS) was 33%. The EFS was 13% for infants aged26 weeks at diagnosis and 43% for infants aged26 weeks. Infants who had blast cells with CD10 negative phenotype with 11q23/MLL involvement were also associated with poor prognosis. However, infants with CD10 positive blasts without 11q23/MLL involvement had a better outcome (EFS 75%). These results suggest that intensive chemotherapy is effective for patients with good prognostic factors, but for infants with poor prognostic factors a more aggressive approach such as stem cell transplantation might be necessary.

Regularly spaced polymer dots are formed on a silicon surface by rubbing a thin polymer plate against the silicon substrate. Typically, the disk-shaped dots are 10 nm in height and 160 nm in diameter, and are separated by 340 nm from each other. It is found that the substrate temperature, the rubbing rate, the polymer viscoelasticity, and wettability against a substrate surface must be within a certain range to produce the aligned dots.

Umbilical cord-blood (CB) has been used as a source of hematopoietic stem cells in pediatric patients with sibling donors. As a result of the success with CB transplantation from sibling donors, pilot programs for the banking of unrelated donor CB were initiated in the organization of Kanagawa Cord Blood Bank, Japan in 1995. As of December 1997, unrelated donor CB was used to reconstitute hematopoiesis in seven patients aged 0.7-12.8 years, weighing 7-36 kg with high-risk leukemia (n = 5), myelodysplastic syndrome (n = 1), and immunodeficiency syndrome (n = 1). Engraftment of CB was achieved in six patients. The absolute neutrophil count reached 500/microliter in a median of 27 days; a platelet count of 20,000/microliter was reached by a median of 64 days in three patients who could be evaluated. Five patients are currently surviving. Grade I GVHD developed in three patients and grade III in one patient; no GVHD developed in three patients. Although only a small number of patients have been studied and the period of observation is too short to determine long-term survival, HLA-matched or HLA-mismatched CB from unrelated donors can provide an alternative source of hematopoietic reconstitution for clinical transplantation.

We analyzed PyNPase expression discriminating between cancer and tumor stroma of the colorectum by Western blotting using a newly developed extraction method from microdissected tissue sections fixed with buffered formalin. Analysis of 98 colorectal cancers revealed that PyNPase was as high as 70.2 +/- 18.5 unit/mg protein in the stroma fraction (SF), whereas it was 45.1 +/- 10.5 in the cancer fraction (CF) (p0.0001). Vessel density was correlated with PyNPase in the SF but not in the CF. In stage IIIb, 11 cases expressing a high level of PyNPase in the CF showed poorer prognosis than 10 cases with low-level PyNPase expression (p0.05), although the level of PyNPase expression in the SF did not affected the patients prognosis. Immunohistochemical examination indicated that PyNPase in the SF was mainly produced by macrophages (M phi), and therefore we investigated the profile of PyNPase production by M phi. In in vitro experiments PyNPase production by M phi was greatly enhanced by stimulation with OK-432, and the culture supernatant had the ability to convert 5'DFUR to 5-FU.

Between 1986 and 1997, we treated 55 patients with liver metastases of breast cancer. In this study, the clinical features and effects of systemic or intra-arterial chemo-endocrine therapy for these patients were reviewed to clarify the characteristics of liver metastases and establish the optimum therapy. One of the 55 patients underwent hepatectomy, 25 were treated with systemic chemo-endocrine therapy [A] and 10 were treated with one-shot intra-arterial chemoembolization through hepatic artery [B] while the other 19 were given hepatic arterial infusion chemotherapy [C]. The response rate in the group [B] and [C] were better than in group [A], whereas there was no significant difference in survival time among the three groups. There were 14 cases (25.5%) among them showing metastasis in the thoracico-abdominal lymph nodes. In these patients, liver metastases seemed to have occurred through the lymphogenic route. In the intra-arterial chemotherapy ([B] + [C]) group, the survival time of patients with metastasis in the thoracico-abdominal lymph nodes was significantly shorter than that of patients without metastasis (p = 0.01). This study suggests that intra-arterial chemotherapy combined with MPA should be effective and useful for advanced breast cancer patients with liver metastases. And for lymphogenic liver metastases, it should be necessary to be combined with more intensive systemic chemo-endocrine therapy.

A total of 91 breast cancer patients died of advanced and recurrent breast cancer at the Osaka Teishin Hospital from 1986 to 1996. There were 18 cases (19.8%) among them showing hypercalcemia (serum corrected Caor = 11.0 mg/dl). These 18 cases were analyzed to determine the incidence of hypercalcemia and to find a more effective treatment. All these patients had multiple bone metastases during their clinical course, and six patients (33.3%) had pathologic bone fracture just before the occurrence of hypercalcemia. Their common symptoms were general fatigue, gastrointestinal symptoms, renal dysfunction or neurological symptoms. There was no definitive correlation between clinical signs and serum calcium values. Among various therapies, the use of pamidronate disodium (Aredia) in combination with hydration, steroid and calcitonin was found to be the most effective treatment for hypercalcemia. The survival time from the diagnosis of hypercalcemia in the patients undergoing treatment with Aredia was significantly better than without it (p0.01). This suggests that Aredia should be effective and useful for advanced breast cancer patients with hypercalcemia.

Ten children with myelodysplastic syndrome underwent an allogeneic bone marrow transplantation (BMT) with an intensified conditioning regimen. The median age of the patients was 8 years (range 2-10), and included 6 males and 4 females. The subtype of the disease was refractory anemia (RA) in 4, RA with excess blasts (RAEB) in 4, RAEB in transformation (RAEB-T) in 1, and juvenile chronic myelogenous leukemia (JCML) in 1. All patients were conditioned with high-dose cytosine arabinoside (12000 mg/m2), cyclophosphamide (120 mg/kg) and either total body irradiation (10-13.2 Gy) or busulfan (16 mg/kg or 560 mg/m2). Cyclosporine A and/or methotrexate were used for the prophylaxis of graft-versus-host disease (GVHD). Engraftment was prompt in all but one patient. Severe acute GVHD (grade 3) (n = 1), interstitial pneumonitis (n = 1) and veno-occlusive disease of the liver (n = 1) occurred. The disease relapsed in one patient with RAEB-T. Seven of the 10 patients were alive and disease free 2-74 months after BMT. The disease-free survival rate at 4 years was 69 +/- 15%. All surviving patients were in the full performance status. The examined children with MDS tolerated this intensified conditioning regimen well.

The efficacy of transcatheter oily chemoembolization (TOCE) was evaluated in 82 patients with unresectable hepatocellular carcinoma (HCC) by computed tomography more than 6 months after TOCE. A doxorubicin in oil emulsion (DOE) was administered to 42 cases and an epirubicin in oil emulsion (EOE) was administered to 40 cases. No significant differences were found in the patient background characteristics between the DOE-treated group and the EOE-treated group. Tumor regression of more than 50% of the product of two dimensions was observed in 26 DOE-treated cases and in 25 EOE-treated cases at 1 year or more after TOCE. No difference in antitumor effect was observed between DOE and EOE, although a sufficient dose per tumor volume would be required to manifest an antitumor effect on hepatocellular carcinoma.

Since 1988, 124 patients with hepatocellular carcinoma were treated in our departments. Among them, 31 cases treated by surgical resection and 30 cases administered a combination therapy (Lipiodol [Laboratoire Guerbet, Villepinte, France]-transcatheter arterial embolization [L-TAE] and lipiodol-percutaneous ethanol injection therapy [L-PEIT]) were analyzed retrospectively. The 1-, 3-, and 5-year survival rates were, respectively, 89.0%, 72.7%, and 63.6% for the surgical resection group and 93.3%, 72.8%, and 42.0% for the combination therapy group. The follow-up results at less than 4 years after the procedures revealed that the survival rate with the combination therapy was slightly better than that with the surgical treatment. However, in the subsequent 4 years, the survival rate of the combination therapy group decreased rapidly. The reasons for this deterioration were local recurrence and/or new primary lesions of hepatocellular carcinoma, mainly due to inappropriate ethanol injection. To achieve adequate and accurate injection of ethanol, a 10% volume of Lipiodol was mixed with the ethanol so that the location of the injected ethanol could be easily confirmed. The effectiveness of L-PEIT was thus confirmed by computed tomography, performed on the following day. Defective Lipiodol accumulation in the tumor and/ or neighboring tissues was able to be corrected by additional ethanol injections. With this L-PEIT technique, the tumor necrosis rate is now improving. Therefore, a better prognosis is expected.

Excessive enterogastric reflux following partial gastrectomy is believed to be responsible for the cause of inflammation in the gastric remnant. We examined the effect of FUT-187, a synthetic serine protease inhibitor, on symptoms and endoscopic findings in 33 patients who were diagnosed endoscopically as postgastrectomy gastritis. Patients took 50 mg FUT-187 orally after each meal and at bedtime for 8 weeks. Before treatment, 30 patients (91%) suffered from several symptoms including regurgitation and/or bitter taste in the mouth (49%), epigastric pain (42%) and nausea (36%). From endoscopic observation, erythema was detected in 32 patients, edema in 23 patients and erosion and/or ulcer in 9 patients. After treatment the global improvement rating for subjective symptoms was 76.7% (23/30) and the improvement of endoscopic findings was 63.6% (21/33). Diarrhea was observed in one patient but could be easily controlled by discontinuation of the drug. Our results suggest that FUT-187 can be a useful drug for the treatment of postgastrectomy gastritis with its efficacy and safety.

Twelve patients with liver metastases of breast cancer were treated with hepatic arterial infusion chemotherapy using 20-30 mg/body of epi-adriamycin (epi-ADM) every 2 weeks and continuous infusion of 250 mg/body/day of 5-fluorouracil (5-FU). All patients were followed by systemic chemo-endocrine therapy with oral administration of 600-1,200 mg/day of me droxyprogesterone acetate (MPA) alone or with 600-800 mg/day of 5'-deoxy-5-flurouridine (5'-DFUR). The response rate was 41.7% (5/12 cases). Duration of response was 2-28 months (mean 10 months). At one year, the survival rate was 46.8% (Kaplan-Meier method). As for side effects, gastrointestinal disturbance, bone marrow depression and alopecia were mild. These results suggest that hepatic arterial infusion therapy in combination with MPA is safe and effective for controlling liver metastases of breast cancer.

A case of unusual pulmonary metastasis of neuroblastoma in an 8-year-old girl is presented. Nodular opacities mimicking pulmonary tuberculosis first appeared in lung apices on chest radiographs. They subsequently developed into extensive consolidations with mediastinal involvement. Metastasis of neuroblastoma was confirmed at autopsy.

We have studied the molecular characteristics of the T cell receptor (TcR) genes in 16 patients with CD7+ early T cell acute lymphoblastic leukemia (T-ALL), defined as being positive for CD7 but negative for CD3/4/8, myeloperoxidase (MPO), and CD19/20. Using gene analysis, rearrangement was demonstrated in one patient for immunoglobulin heavy chain (IgH) gene, five for TcR-beta gene, and four for TcR-gamma gene. Fifteen patients (94%) had rearranged band(s) involving the joining region of the TcR-delta chain gene. In nine cases these were the only rearrangements, whereas in six cases TcR-beta and/or TcR-gamma gene rearrangements were found as well. The D delta 2(D delta)J delta 1 rearrangement was demonstrated in 87.5% (14/16) of cases. D delta 2(D delta)J delta 3 was recognized in one patient, D delta 2D delta 3 was found in three, and V(D)DJ using only V delta 2 and V delta 3 was recognized in two patients. We found no V2D delta 3, V3D delta 3, or V1(D)DJ delta rearrangement patterns. Five of nine cases with DDJ delta were positive for cytoplasmic CD3 epsilon(CyCD3 epsilon). Our data suggest that DDJ delta joining occurs at an early stage during T cell differentiation, followed by rearrangements of V delta to the DDJ delta complex. Furthermore, our findings suggest that DDJ delta recombination occurs earlier than expression of CyCD3 epsilon protein products. DDJ delta rearrangements have never been observed in non-T cell malignancies, such as precursor-B-ALL or acute myeloid leukemia. Therefore, detection of DDJ delta rearrangement in the TcR-delta locus is a useful tool to establish lineage and clonality of leukemic cells in the most immature stages of T cell development.

We report two patients with acute leukemias who expressed two types of bcr/abl mRNA. The first case was an 8-year-old boy with acute mixed leukemia in whom the Ph1 chromosome and p210/p190 types of bcr/abl mRNAs were detected at diagnosis. The second case was a 39-year-old male with acute nonlymphocytic leukemia transformed from myelodysplastic syndrome (refractory anemia with excess of blasts). In the latter case, the p210-type mRNA appeared after leukemic transformation, and the p190-type transcript was detected only during the late stage when the Ph1 chromosome was first observed. The leukemias in these two patients were aggressive in their clinical courses. We conclude that the dual expression of p210 and p190 types of bcr/abl is a factor indicating a poor prognosis, and that, in some patients, p190-type bcr/abl may contribute to disease progression.

A total of 125 children, who were diagnosed as having high-risk acute lymphoblastic leukemia (ALL), were treated with two consecutive protocols designated as AL851 (1985-1988) and ALHR88 (1988-1990). All patients received induction therapy consisting of vincristine (VCR), prednisolone (PSL), daunorubicin (DNR), and I-asparaginase (I-Asp). In the ALHR88 protocol, the patients whose blasts in the bone marrow (BM) wereor = 25% on day 14 of induction therapy and who were classified into T-cell type received additional cytosine arabinoside (AraC). After consolidation with intermediate-dose methotrexate (MTX), reinduction therapy including VCR, dexamethasone, and adriamycin followed by high-dose AraC was done for all patients. Intrathecal MTX and 24Gy of cranial irradiation were used to prevent central nervous system leukemia. A maintenance therapy consisting of 6-mercaptopurine, cyclophosphamide, MTX, DNR, VCR, and AraC was administered for 3 years after achieving a complete remission (CR). CR was achieved in 51/55 (92.7%) for AL851 and 68/70 (97.1%) for ALHR88. The 5-year event-free survival rates were 49.1 +/- 6.7% in AL851 and 62.5 +/- 6.1% in ALHR88. The factors related to a poor prognosis were a high initial leukocyte count of greater than 50 x 10(9)/L (P0.001), an L2 morphology of leukemic cells by FAB classification (P = 0.009), the chromosomal abnormality (P = 0.004) and high residual leukemic cells in BM (or = 25%) on day 14 of induction therapy (P0.001). Taking these factors into consideration, more intensive protocols were started in 1990 for the patients with high-risk ALL.

Seventeen patients with liver metastases of breast cancer were treated with a combination of intra-arterial chemotherapy and endocrine therapy at our hospital from 1986 to 1994. Of 17 patients, 9 were treated with transarterial chemoembolization through hepatic artery using 40-50 mg/body of 4'epi-adriamycin (epi-ADM) and lipiodol, and the other 8 were treated with hepatic infusion chemotherapy using 20-30 mg/body of epi-ADM every 2 weeks. All patients were followed by endocrine therapy with oral administration of 800-1,200 mg/day of medroxyprogesterone acetate (MPA). The results were as follows: 1) The comparison of response rate between the two groups was not substantially changed (44.4% x 4/9 in TAE group and 50.0% x 4/8 in Reservoir group). 2) Duration of response was 4-45 months (mean 25 months) in TAE group and 3-15+ alpha months (mean 8.7 months) in Reservoir group. But in the latter group, 3 patients are now under treatment. 3) At one year, the survival rates were 44.4 percent in TAE group and 50.0 percent in Reservoir group. We conclude that combination of intra-arterial chemotherapy and endocrine therapy is a useful treatment modality for controlling liver metastases of breast cancer.

Seventy-three children with acute nonlymphocytic leukemia (ANLL) have been treated with ANLL-85 and ANLL-88 protocol at Kyushu-Yamaguchi Children's Cancer Study Group between June, 1985 and February, 1993. Ten boys and 10 girls (0y4m-16ylm) were treated with the ANLL-85 protocol. The complete remission (CR) rate was 75% and the 5-year event free survival (EFS) was 20 +/- 9%. It was terminated because of frequent early relapse (within 6 months after CR). Thirty-four boys and 19 girls (0y3m-17ylm) were treated with the ANLL-88 protocol. The CR rate was 85% and the 5-year EFS was 32 +/- 7%. Early relapse rate with ANLL-88 was lower than that of ANLL-85, however 9 cases relapsed after terminating therapy. Although bone marrow transplantation (BMT) from related donors during the first CR was effective in ANLL-88, EFS was not improved. Recognition of risk factors and appropriate chemotherapy regimens with or without the support of stem cell transplantation may be necessary to cure children with ANLL.

We report a 42-year-old woman with acute lymphoblastic leukemia who received allogeneic bone marrow transplantation (BMT) in the first remission from her 75-year-old, HLA-identical, MLC-non-reactive mother. Considering the difficulty to obtain a sufficient number of bone marrow cells from such an old donor, we harvested the cells (2.31 x 10(8)/kg) on day -37 and cryopreserved them until use. BMT was performed on June 3rd, 1993 after conditioning regimen with total body irradiation, high-dose AraC and cyclophosphamide. Graft-versus-host disease (GVHD) prophylaxisis was attempted by cyclosporin A and short-term methtrexate. Her hematopoietic recovery was favorable with no signs and symptoms of GVHD as far as day 218.

Detection of non-palpable (T0) breast cancer by pathological nipple discharge is possible 3 years or more earlier than tumorous breast cancer. However, the definite diagnosis of T0 breast cancer has been considered to be very difficult because the standard diagnostic method such as exfoliative cytology and ductography were not totally reliable. In 1985 we first demonstrated the significance of CEA measurement in nipple discharge for diagnosis of T0 breast cancer. Since then CEA activity in nipple discharge was estimated in 60 patients with breast diseases by means of enzyme immunoassay using monoclonal anti CEA antibody. They include 17 with T0 breast cancer, 9 with borderline lesion, 20 with intraductal papilloma and 14 with fibrocystic diseases. When the cut off value of CEA concentration was set at 600 ng/ml, the sensitivity, specificity and accuracy were 76.5%, 100% and 92.2%, respectively. These levels were higher than those for mammography or cytology. In the past 7 years, 13 cases of T0 breast cancer were detected in our hospital. They accounted for 2.5% of total breast cancer cases. In conclusion, CEA measurement in nipple discharge is a useful method for the diagnosis of non-palpable breast cancer.

A randomized controlled clinical trial was conducted to compare the use of farmorubicin (FARM) and adriamycin (ADR) in Lipiodol transcatheter arterial chemoembolization (L-TAE) as a treatment of hepatocellular carcinoma. In all, 192 hospitals participated, and 415 patients were enrolled in the study during the period from October 1989 through December 1990, and their data were collected. The patients were randomly allocated to group A (FARM) or group B (ADR) by a central telephone registration. Several clinical characteristics were slightly worse in group A than in group B, but there was no statistically significant difference. The actual doses of FARM and ADR were 72 mg/body and 48 mg/body, respectively. Additional treatments, including repeated TAE or surgery, were given to 248 patients. The 1- and 2-year survival rates were 69% and 44% for group A and 74% and 57% for group B, respectively. The difference was marginally significant (P value in the log-rank test, 0.038). When each group of patients was classified into two subgroups, i.e., high-risk and low-risk categories, based on the severity index calculated by the Cox regression model from significant prognostic factors, the ADR subgroup was significantly superior to the FARM subgroup in the low-risk category, but there was no significant difference between the subgroups in the high-risk category. The change in the serum alpha-fetoprotein level, the extent of Lipiodol accumulation in the tumor, and the extent of tumor reduction did not show any significant difference between the groups. At the above-mentioned doses, ADR seemed to have efficacy almost the same as or slightly superior to that of FARM in L-TAE for the treatment of hepatocellular carcinoma.