Life-threatening airway obstruction due to retropharyngeal and cervicomediastinal hematomas following stellate ganglion block.

Airway obstruction by retropharyngeal or cervicomediastinal hematomas following stellate ganglion block is life-threatening. The onset of the initial symptoms of retropharyngeal or cervicomediastinal hematoma usually occurs 2 hours or more after stellate ganglion block. We report the rare complication of airway obstruction leading to respiratory arrest caused by retropharyngeal and cervicomediastinal hematomas due to rebleeding of an ascending cervical artery 3 days after stellate ganglion block.

Expression of periostin in patients with non-small cell lung cancer: correlation with angiogenesis and lymphangiogenesis.

The aim of this study was to evaluate periostin expression measured immunohistochemically in patients with non-small cell lung cancer (NSCLC) and to determine its association with clinical features, prognosis, angiogenesis, and lymphangiogenesis. We investigated periostin expression in a series of 88 patients with NSCLC. We also determined whether expression of periostin correlated with microvessel density and lymphatic microvessel density. Periostin was expressed in 42% of 88 patients. Its expression was significantly correlated with tumor size, lymph node metastasis, disease stage, and lymphatic invasion (p=0.0128, 0.0015, 0.0310 and 0.0273, respectively). There also was a significant relation between periostin expression and microvessel density and lymphatic microvessel density (all p<0.0001). Five-year survival rates were better in patients with negative periostin expression than in those with positive periostin expression (p=0.0044). Periostin expression was not significant in a multivariate additive model. Our findings show that periostin correlates with increased tumor progression and a worse prognosis in NSCLC, as well as with angiogenesis and lymphangiogenesis.

[Resected lung cancer with production of CA19-9].

We report 2 cases of resected CA19-9 producing adenocarcinoma of the lung. Immunohistochemical studies of the specimens in 2 cases showed positive staining for CA19-9 in most of tumor cells. The serum CA19-9 levels decreased after operations and effective chemotherapy in these cases. But the serum CA19-9 levels increased with regrowth of tumors or with no therapeutic gain by chemotherapy. The serum CA19-9 level was useful to evaluate the therapeutic effect of surgery and chemotherapy, and may be effective in detecting the recurrence of lung cancer.

Prediction of anti-tumour effect of thermochemotherapy with in vitro thermochemosensitivity testing for non-small cell lung cancer.

PURPOSE: We investigated whether it is possible to predict the antitumour effects of thermochemotherapy from the results of anticancer agent sensitivity testing. MATERIALS AND METHODS: We produced a nude mouse cancer model using 4 lung cancer cell lines. Animals were divided into 4 groups: Thermotherapy (HT group), chemotherapy (CT group), thermochemotherapy (HT+CT group), and no therapy (NT group). Comparison of in vivo and in vitro effects were performed using cisplatin (CDDP), doxorubicin (ADR) and vinorelbine (NVB). In vivo thermotherapy was performed using the Thermotron RF IV, and radiofrequency (RF) capacitative hyperthermia device that induces a localised temperature of 42.0 degrees C for 45 min. The collagen gel embedded culture drug sensitivity test (CD-DST) was used for in vitro chemosensitivity analysis of the anticancer agents. In vitro thermochemotherapy was performed using a modified CD-DST method, with the incubator set at 42.0 degrees for the first hour of the 24 hours drug exposure period. RESULTS: A good correlation was seen between in vivo and in vitro treated/control ratios (T/C%) in the HT group (R = 0.91, p = 0.09). Good correlations were also seen between in vivo and in vitro T/C in all cell lines in the CT group (R = 0.759, p = 0.09) and the HT+CT group (R = 0.65, p = 0.02). True positive rate was 87.5% (7/8), and true negative rate was 100% (4/4). Sensitivity, specificity and accuracy were 100% (7/7), 80% (4/5), and 91.7% (11/12) respectively. CONCLUSION: A modified CD-DST using an exposure temperature of 42 degrees C can be used to predict the antitumour effect of thermochemotherapy.

Angiotensin AT(1) receptor antagonism normalizes retinal blood flow and acetylcholine-induced vasodilatation in normotensive diabetic rats.

AIMS/HYPOTHESIS: The renin angiotensin system is emerging as a potential therapeutic target for diabetic retinopathy. This study examines the effects of angiotensin-converting-enzyme inhibition by captopril and angiotensin AT(1) receptor antagonism using candesartan-cilexetil on retinal blood flow and acetylcholine-stimulated vasodilatation in normotensive diabetic rats. METHODS: Non-diabetic or streptozotocin-induced diabetic rats were treated for 2 weeks with captopril (100 mg/kg/day) or candesartan cilexetil (2 mg/kg/day). Retinal haemodynamics were measured using video fluorescein angiography. Effects of exogenous acetylcholine on retinal haemodynamics were examined following intravitreal injection. Total retinal diacylglycerol was labelled using diacylglycerol kinase, separated by thin-layer chromatography, and quantified using autoradiography. RESULTS: Diabetic rats had prolonged retinal mean circulation time and decreased retinal blood flow compared with non-diabetic rats. Treatment of diabetic rats with either captopril or candesartan blocked the development of these blood flow abnormalities. Intravitreal injection of acetylcholine (10(-5) mol/l) in non-diabetic rats increased retinal blood flow by 53.9+/-22.0% relative to baseline whereas this response to acetylcholine was blunted in diabetic rats (4.4+/-19.6%, p<0.001). Candesartan treatment of diabetic rats restored the acetylcholine-stimulated retinal blood flow response to 60.0+/-18.7% compared with a 56.2+20.1% response in candesartan-treated non-diabetic rats. Total retinal diacylglycerol levels were increased in diabetic rats (3.75+/-0.98 nmol/mg, p<0.05) compared with non-diabetic rats (2.13+/-0.25 nmol/mg) and candesartan-treatment of diabetic rats normalized diacylglycerol levels (2.10+/-0.25 nmol/mg, p<0.05). CONCLUSION/INTERPRETATION: This report provides evidence that angiotensin-converting enzyme inhibition and AT(1) receptor antagonism ameliorates retinal haemodynamic dysfunctions in normotensive diabetic rats.

Syntheses of two neuromedin U (NMU) analogues and their comparative reducing food intake effect in rats.

To examine the roles of aromatic rings Tyr residues at positions 1 and 6 and Phe residues at positions 16, 17 and 19 of rat neuromedin U-23 (NMU-23) (Tyr-Lys-Val-Asn-Glu-Tyr-Gln-Gly-Pro-Val-Ala-Pro-Ser-Gly-Phe-Phe-Leu-Phe-Arg-Pro-Arg-Asn-NH(2)) for reducing food intake activity in male Wistar rats, two NMU-23 analogues, [Phe(4F)(16,17,19)]NMU-23 and [Tyr(Me)(1,6)]NMU-23, were synthesized by Fmoc strategy of manual solid-phase method. The synthetic NMU-23 showed reducing effect on food intake in rats. [Phe(4F)(16,17,19)]NMU-23 exhibited higher reducing food intake effect than that of NMU-23. On the contrary, [Tyr(Me)(1,6)]NMU-23 showed no reducing effect on food intake in rats than that of NMU-23.

Synthesis and immunological effect of thymic humoral factor-gamma 2 analogues.

Nine analogues of thymic humoral factor (THF)-gamma 2 were prepared by the solid-phase method and their in vitro restoring effect on the impaired blastogenic response of phytohemagglutinin(PHA)-stimulated T-lymphocytes of uremic patients with infectious diseases were examined. The results were as follows: [Arg6]-THF-gamma 2 exhibited higher restoring activity than that of our synthetic THF-gamma 2. [Sar4]-, [Val1]-, [Arg3]-, [Gly5]-, and [Asn3]-THF-gamma 2 were also active, but less potent than that of our synthetic THF-gamma 2. Three other peptides, [beta Ala4]-, [Arg2]-, and [Gln2]-THF-gamma 2, did not show any restoring activity on the impaired blastogenic response of uremic patients with infectious disease.

Synthesis and immunological effect of thymic humoral factor-gamma-2 analogues.

Nine analogues of thymic humoral factor (THF)-gamma-2 were prepared by the solid-phase method, and their in vitro restoring effect on the impaired blastogenic response of phytohemagglutinin(PHA)-stimulated T-lymphocytes of uremic patients with infectious diseases were examined. The results were as follows: [Arg6]-THF-gamma-2 exhibited higher restoring activity than that of our synthetic THF-gamma-2. [Sar4]-, [Val1]-, [Arg3]-, [Gly5]-, and [Asn3]-THF-gamma-2 were also active but less potent than that of our synthetic THF-gamma-2. Three other peptides, [beta-Ala4]-, [Arg2]-, and [Gln2]-THF-gamma-2, did not show any restoring activity on the impaired blastogenic response of uremic patients with infectious disease.

Synthesis of two neuromedin U (NMU) analogues and their comparative effect of reducing food intake in rats.

To examine the roles of aromatic rings, Tyr residues at positions 1 and 5 and Phe residues at positions 16, 17, and 19 of rat neuromedin U-23 (NMU-23) (Tyr-Lys-Val-Asn-Glu-Tyr-Gln-Gly-Pro-Val-Ala-Pro-Ser-Gly-Gly-Phe-Phe-Leu-Phe-Arg-Pro-Arg-Asn-NH2) for reducing food intake activity in male Wistar rats, two NMU-23 analogues, [Phe(4F)16,17,19] NMU-23 and [Tyr(Me)1,6]NMU-23, were synthesized by Fmoc strategy of manual solid-phase method. The synthetic NMU-23 showed reducing effect on food intake in rats. [Phe(4F)16,17,19]NMU-23 exhibited higher reducing food in take effect than that of NMU-23. On the contrary, [Tyr(- Me)1,6]NMU-23 showed no reducing effect on food intake in rats than that of NMU-23.

[Clinical analysis of surgically resected multiple primary lung cancer].

Synchronous and metachronous lung cancer is occasionally encountered. Frequency of the occurrence is increasing because of recent progress of imaging technique such as high resolution CT and CT based annual lung survey. We analyzed clinical characteristics of both synchronous and metachronous lung cancer treated surgically in our facility. There were 20 cases of multiple lung cancer cases, which is consisted of 12 synchronous multiple lung cancer cases and 8 metachronous lung cancer cases. Mean age was 62 years old and there were 14 male and 6 female cases. Among synchronous group, 8 cases have multiple shadow in ipsilateral hemithorax and 4 cases in both side. Surgery was carried out according to the extent of the disease and lung reserve. Associated cancer was diagnosed stage IA or IB in all cases. Five-year survival was 58.9%. Meanwhile, as regards to metachronous group, mean interval between first cancer and second cancer was 73 months. Seven cases have contralateral second primary lung cancer and one case has ipsilateral second primary lung cancer. In 3 cases, histology of the first and the second disease were different and in 5 cases that were the same. The first procedures were complete resection with systemic mediastinal LN dissection. The second procedures were determined based on the lung reserve. Pathological stage of the second disease were either stage IA or IB. There were no operative mortality and 5 years survival was 75%. Since there is no operative mortality and the outcome seems satisfactory when the patient has enough lung reserve, aggressive surgical resection should be considered in the case of multiple primary lung cancer. There is an increasing chance of synchronous multiple primary lung cancer because of improvement of imaging system. We have to prepare new therapeutic strategy for those patients.

[Order-made therapy for early lung cancer patients].

To give optimal treatment to the patients with early lung cancer, we are trying to establish two new techniques to select the patients of poor prognosis and sensitive to the chemotherapy. To pick up the patients of poor prognosis nevertheless the early stage of their lung cancer, we are developing a new method to detect cancer cells floating in the peripheral blood flow with RT-PCR using cancer specific mRNA. To choose optimal chemotherapy regimens, we have established a new chemosensitivity testing (collagen gel droplet embedded culture drug sensitivity test: CDDST) for non-small cell lung cancer (NSCLC). Median survival time (MST) of the patients (n = 11) with unresectable NSCLC, who were given optimal chemotherapy according to CDDST, was 15.8 months and MST of those (n = 16) who did not have any sensitive agents according to CDDST was 5.6 months. There was significant difference between these two groups (p = 0.0048; logrank).

Syntheses and effect of bombesin-fragment6-14 and its four analogues on food intake in rats.

A nonapeptide, H-Asn-Gln-Trp-Ala-Val-Gly-His-Leu-Met-NH2, corresponding to amino acids 6 to 14 of bombesin and its four analogues were synthesized by a solid-phase method and were tested for their comparative effect on reducing activity on food intake using male Wistar rats. The synthetic bombesin-fragment6-14 showed reducing effect on food intake using male Wistar rats. Of the synthetic analogues, [Phe(4F)13]bombesin-fragment6-14 exhibited the most potent effect. The reducing effect on food intake of [Sar11]bombesin-fragment6-14 was lower than that of our synthetic bombesin-fragment6-14, but the other two analogues, [betaAla11]bombesin-fragment6-14 and [1-Nal8]bombesin-fragment6-14 showed no reducing effect on food intake in rats.

Syntheses of two deacetyl-thymosin beta4 analogs and their anti-inflammatory effect on carrageenin-induced edema in the mouse paw.

Two [Met(0)6]deacetyl-thymosin beta4 analogs containing Phe(4F) or Tyr(Me) at position 12 were synthesized by the manual solid-phase method, and their anti-inflammatory effect on carrageenin-induced edema in the mouse paw was studied. Fluorination of the para-position of Phe12 resulted in a marked antiinflammatory effect on carrageenin-induced edema in the mouse paw compared with that of our synthetic [Met(0)6]deacetyl-thymosin beta4, but the other analog, [Met(0)6, Tyr(Me)12]deacetyl-thymosin beta4, showed a marked reduction of the anti-inflammatory effect.

Corneal advanced glycation end products increase in patients with proliferative diabetic retinopathy.

OBJECTIVE: To evaluate corneal advanced glycation end product (AGE) fluorescence in patients with diabetes and in healthy control subjects. RESEARCH DESIGN AND METHODS: Corneal autofluorescence was measured in 26 eyes of 26 patients with type 2 diabetes (mean age 57.0 years; mean disease duration 12.2 years; mean HbA1c 7.1%) and 13 eyes of 13 healthy age-matched control subjects (mean age 57.9 years). The patients with type 2 diabetes were divided into the following groups: patients without diabetic retinopathy (DR), patients without proliferative diabetic retinopathy (PDR), and patients with PDR. Corneal autofluorescence was measured by fluorophotometry with the wavelength that is characteristic of AGE fluorescence (excitation and emission 360-370 nm and 430-450 nm, respectively). We defined peak corneal autofluorescence levels as corneal AGE fluorescence values. We compared the corneal AGE fluorescence values in the four groups. RESULTS: In the PDR group (11.9 +/- 3.9 arbitrary units [mean +/- SD]), the corneal AGE fluorescence values were significantly higher compared with the control subjects (6.9 +/- 1.3 arbitrary units), the patients without DR (7.4 +/- 2.1 arbitrary units), and the patients without PDR (6.9 +/- 2.2 arbitrary units) (P < 0.05). CONCLUSIONS: We found that corneal AGEs may increase in patients with diabetes and PDR compared with control subjects, patients without DR, and patients without PDR. In the patients with PDR, increased corneal AGEs may play a role in diabetic keratopathy.

Thymoma with pemphigus foliaceus.

A 75-year-old Japanese woman was referred to us because of an anterior mediastinal mass. Crusts and shallow erosions developed 10 months earlier on her upper chest, back, and scalp. Pemphigus foliaceus was diagnosed based on histological examination of skin biopsy specimens and positivity for serum anti-desmoglein 1 antibody by enzyme-linked immunosorbent assay. Neurological examination and electromyography ruled out myasthenia gravis. Total thymectomy was performed, and the postoperative pathology studies showed mixed lymphoepithelial thymoma. One year after the resection, the eruption and alopecia improved and the serum anti-desmoglein 1 antibody titer decreased, suggesting a beneficial effect of thymectomy on thymoma-related pemphigus.

Changes in blood-retinal barrier permeability in form deprivation myopia in tree shrews.

To study the correlation between blood-retinal barrier (BRB) permeability and development of form deprivation (FD) myopia, FD was induced in tree shrews. The refractive error and the axial dimensions of the optical elements were measured. Ocular fluorescence was measured before and after fluorescein-Na injection. The inward permeability (P(in)) of the BRB was measured before and 15, 30, and 45 days after FD was induced. FD eyes became significantly myopic 15 days after FD was induced (P<0.01), and myopia progressed 45 days after FD was induced compared with untreated controls. Neither anterior chamber length nor lens thickness changed significantly. The vitreous chamber in FD eyes, however, was significantly elongated from 15 days after FD was induced (P<0.01) compared with controls. The P(in) ratio (P(in) [FD eye]/P(in) [untreated control]), increased significantly 45 days after FD was induced (P<0.05). In FD myopia in tree shrews, the BRB permeability increases abnormally. Impaired BRB function might be a secondary effect of myopia development rather than the cause of myopia.

Synthesis of [I-NaI3]] thymopoietin II and examination of its immunological effect on the uremic T-lymphocytes.

A TP II analogue, [1-Nal3] TP II, was synthesized by a conventional solution method, followed by deprotection with 1M TFMSA-thioanisole (molar ratio 1:1) in TFA in the presence of Me2Se and m-cresol as scavengers. The synthetic [1-Nal3] TP II, TP II and [Phe (4 F)3] TP II were tested for comparative effect on the impaired T-lymphocyte transformation by PHA in uremic patients suffering from recurrent infectious diseases. The synthetic analogue was found to have stronger restorative activity than those of our synthetic TP II and [Phe (4F)3] TP II.

Relationship between autofluorescence and advanced glycation end products in diabetic lenses.

Autofluorescence and advanced glycation end product (AGE) levels were measured in the lenses of 9 diabetic Chinese hamsters and 6 age-matched controls. Lens autofluorescence also was measured in 37 diabetic patients and 14 age-matched controls. Lens autofluorescence values were measured noninvasively with a lens measurement system using color filters with peak transmission at 365- and 434-nm wavelengths (excitation and emission, respectively) that are characteristic of AGE fluorescence. The peak lens autofluorescence level was used as the lens autofluorescence value, and the mean lens autofluorescence values from both eyes of each subject were used for statistical analysis. The AGE levels in one lens from each hamster were measured by noncompetitive enzyme-linked immunosorbent assay with a polyclonal anti-AGE antibody. We found a 2.2 times increase of the mean lens autofluorescence value of diabetic hamsters in comparison with that of controls (P<0.01). We also found a 1.5 times increase of the mean AGE level from the lenses of diabetic hamsters in comparison with that of controls (P<0.01). Moreover, a statistically significant positive correlation between the AGE level and autofluorescence value in the same lenses was observed in all hamsters (rho=0.58, P<0.05). In human subjects, we found a 1.4 times increase of the mean lens autofluorescence value of diabetic patients in comparison with that of age-matched controls (P<0.01). Our results suggest that non invasive measurement of lens autofluorescence may be a guide to AGE levels in lenses.

[Clinical analysis in patients undergoing extended resection of pT3 non-small cell lung cancer].

Among pT3 cases there contain various subgroups in terms of the organ which is involved in. We analyzed medical records of 85 consecutive patients who underwent extended surgery with diagnosis of pT3 excluding interlober invasion. As regards to the site of invasion, there are not significant differences in survival between pleural invasion, chest wall involvement, pericardial invasion, and diaphragmatic invasion. However, survival of patients who showed involvement of main bronchus seemed better than other groups. Survival of pT3 cases are in part determined by lymph node involvement, N0 group showed 36.0% 5 year survival rate whereas N1 group 20.0%, and there are no patient with N2 disease who survived 5 years. Among pleural and chest wall involvement group, N0 group showed 34.2% 5 year survival and there are no survival in N1 and N2 group. As regards to histologic subgroups, there are not significant differences between each group. Thus we conclude that in pT3 cases, N0 cases are the best candidate for surgical resection, and that adjuvant therapy is necessary for those with N1 or N2 involvement. Cases with bronchial extension should not be argued in the same field of locally invasive lung cancer because of better survival.

Corneal and lens autofluorescence in young insulin-dependent diabetic patients.

To study the early ocular abnormalities in young diabetic patients, corneal and lens autofluorescence was measured by fluorophotometry in 30 eyes of 30 insulin-dependent diabetic patients without retinopathy. The lens [f(l)] and the corneal [f(c)] autofluorescence values in diabetic patients were significantly higher than in controls. In diabetic patients, f(l) was significantly correlated with the duration of diabetes, the f(c) was significantly correlated with the duration of diabetes and the indices of metabolic control, i.e. HbA1c and fructosamine. Our study demonstrated that young diabetic patients clearly had corneal and lens abnormalities before the appearance of overt diabetic retinopathy. The f(c) value might be a good indicator of metabolic control in diabetic patients.