Diagnosis of chest wall invasion by lung cancer: useful criteria for exclusion of the possibility of chest wall invasion with MR imaging.

PURPOSE: To compare the accuracy of thin-section CT, conventional static MR imaging (conventional MRI), and breathing dynamic echo planar magnetic resonance imaging (BDEPI) in evaluating lung cancer invasion to the chest wall. MATERIALS AND METHODS: Thin-section CT, conventional MRI, and BDEPI were performed preoperatively in 20 patients suspected of having primary lung cancers adjacent to the chest wall on conventional CT. The results of imaging findings were compared with those of surgical and histopathological findings. RESULTS: All patients were confirmed to have no chest wall invasion after surgery. By thin-section CT, 10 of 20 patients were correctly diagnosed as having no chest wall invasion (50% specificity). Two of the 20 patients were incorrectly diagnosed as having chest wall invasion by conventional MRI and BDEPI (90% specificity). CONCLUSION: When chest wall invasion is suspected on CT scans, static and breathing dynamic MRI are recommended to avoid false positive interpretations.

Molecular cloning and sequence analysis of an endoinulinase gene from Penicillium sp. strain TN-88.

A genomic DNA segment and cDNAs encoding an extracellular endoinulinase of Penicillium sp. strain TN-88 were cloned and sequenced. Southern blot analysis indicated that the endoinulinase gene (inuC) was present as a single copy in the genome. An open reading frame, consisting of 1,545 bp, was not interrupted by introns, and it encoded a 25 amino acid signal peptide and a 490 amino acid mature protein. The mature protein contained three Cys residues and ten potential N-linked glycosylation sites. Three distinct transcriptional start points were observed at positions -242 (A), -215 (A), and -75 (C) from the start codon. The 5'-noncoding region had a putative TATA box at position -120 (TATATATA) and two contiguous CAAT sequences at -159 to -151. The deduced amino acid sequence showed 72 and 85% identities with those of Aspergillus niger and Penicillium purpurogenum endoinulinase genes, respectively. A neighbor-joining tree showed that fungal endoinulinases form a distinct cluster from other members of the beta-fructofuranosidase superfamily and that they are more closely related to bacterial levanases than to a fungal fructosyltransferase, yeast invertases, or a yeast exoinulinase.

Squamous cell carcinoma of the external auditory canal: two cases treated with high dose rate 192Ir remote afterloading system (RALS).

We report two cases of early-stage external auditory canal cancer treated by intracavitary irradiation with a high dose rate (HDR) 192Ir remote afterloading system (RALS) for preoperative treatment. A 6-Fr catheter for the HDR 192Ir remote afterloader, fixed by a plastic earplug, was inserted into the external auditory canal in two cases (case 1, T2N0M0; case 2, T1N0M0). The total intracavitary radiation dosages were 50 Gy (10 Gy/2 Fr/wk for 5 wks) for case 1, and 42 Gy (15 Gy/5 Fr/wk for 3 wks) for case 2. No external irradiation was given in either case. Surgical resection was performed in both cases, three to four weeks after irradiation. Histopathological examination confirmed the post-irradiation changes of necrosis, hyalinosis, and calcification, although vivid cancer cells remained. In preoperative irradiation of external auditory cancer, this method, although limited to treating early-stage cancers, may be a modality of choice for its efficacy and less severe side effects.

Transcriptional analysis of two endoinulinase genes inuA and inuB in Aspergillus niger and nucleotide sequences of their promoter regions.

Aspergillus niger 12 contained two copies of endoinulinase genes (inuA and inuB) in the genome (K. Ohta et al., Biosci. Biotechnol. Biochem., 62, 1731-1738, 1998). The inuA- and inuB-specific DNA probes were constructed according to the respective 3'-noncoding sequences that diverged from each other. Poly(A)+ RNA was prepared from mycelia grown on inulin, fructose, or glucose in submerged culture. Three endoinulinase cDNA sequences that corresponded to the coding regions and their 5'- and 3'-flanking regions were obtained by reverse transcription and subsequent polymerase chain reaction. Southern blot analysis revealed that the amplified cDNA 3'-noncoding sequences hybridized to the inuB probe but not to the inuA probe, regardless of the carbon source. The data suggest that only the inuB gene was transcribed constitutively. Four distinct 5' ends of the transcripts were observed at positions -80(A), -72(G), -69(A), and -65(A) from the start codon. The inuB mRNAs were polyadenylated at various sites between 94 and 297 bp downstream of the stop codon. We have determined the nucleotide sequences of the 1201- and 1017-bp 5'-noncoding regions of the inuA and inuB genes, respectively. The inuB promoter region included a putative TATA box at -116 (TATATA).

[Local injection of cisplatin for vaginal stump recurrence of gynecological malignant tumor].

Cisplatin (CDDP) has been reported to be a most effective drug for gynecologic cancer. We investigated the efficacy of local injection of CDDP. The subjects are 3 patients with local recurrence of vaginal stump in a gynecologic malignant tumor. CDDP was injected locally in the tumor using a single dose of 10 mg for 5 days. The effects of the therapy were evaluated by cytology, tumor markers, ultrasonography and CT. The results of this therapy were PR in one patient and NC in two patients. One patient with ovarian carcinoma stage III c survived for 11 months following this therapy with CDDP. Her genital bleeding was stopped, and her performance status was improved. In conclusion, it is suggested that this therapy is useful for vaginal recurrence of a gynecologic malignant tumor. We hope that wider use of this method will improve the quality of life for end-stage patients.

[Extramedullary plasmacytoma with multiple metastasis following a maxillary plasmacytoma].

A 67-year old man noticed swelling of left maxillary in October 1992. Surgical biopsy of the left maxillary tumor revealed the plasmacytoma at the department of oral surgery. The Tumor disappeared after radiation therapy. He was admitted with dizziness and tarry stool in June 1994. We found left cervical and abdominal paraaortic lymph node swellings by the computer tomography. He died inspite of chemotherapy in December. Autopsy showed that plasma cells diffusely and nodularly invased in all alimentary tract with multiple ulcerations. Invasion was also observed in the liver, lungs, thyroid, heart, kidneys, and adrenals. The plasma cells in the liver showed IgG kappa type by tissue immunostain. Diffuse invasion of extramedullary plasmacytoma is very rare in alimentary tract and many other organs. This case may be value to delineate the nature of this disease.

[Nineteen multiple primary cancer cases of 100 patients undergoing lung cancer resection].

In our department, half of 100 consecutive lung cancer resection cases were over the age of 70 years. In the same 100 patients, nineteen cases had multiple primary cancers. Sixteen cases had double, two cases had triple, one case had quadruple primary cancers. The incidence rate of multiple primary cancers involving the lung was 19%. This incidence of 19% is higher than the others ever reported in Japan. It was concluded, when lung cancer patients were elder, that there was increasment in the frequency of multiple cancer cases involving lung, and there was a high possibility of the occurrence of 2nd and 3rd primary cancers.

New development of integrated CT simulation system for radiation therapy planning.

In order to put more accurate radiotherapy into practice, a radiotherapy planning system using CT, which is named CT simulation system, has been developed and introduced at Kobe University Hospital. The CT simulation system consists of a CT scanner, an image processing work-station, and a laser marking system. The target area of radiation is determined on each CT axial image or scout view in the work-station. Three-dimensional treatment planning is feasible on the basis of the two-dimensional tumor information in CT axial images. After setting treatment parameters, the contour of the radiation field on beam's eye view and the iso-center position are calculated by computer. This system makes it possible to choose an appropriate irradiation method and an optimal dose distribution. In the present study we examined the fundamental capability of this system. The laser marking system proved to have a very high degree of accuracy. The outcome of a phantom test raised the strong possibility that this system may be applied clinically. In addition to these basic findings, this paper describes preliminary clinical observations that support the good reproducibility of the radiation field projected with the CT simulator. In conclusion, this system is of high value for radiation therapy planning.

Effects of danazol at the immunologic level in patients with adenomyosis, with special reference to autoantibodies: a multi-center cooperative study.

OBJECTIVE: We attempted to evaluate the effects of danazol on autoantibodies, in particular, to phospholipids, and on the immune system in patients with adenomyosis. STUDY DESIGN: Forty-two patients with adenomyosis who had high titers of autoantibodies were randomly chosen, and they received 400 mg/day of danazol for 4 months (n = 22) or underwent hysterectomy (n = 20). RESULTS: Among the six autoantibodies we investigated, the incidence of antiphosphatidylinositol immunoglobulin G was the highest (42.9%), followed by antiphosphatidylglycerol immunoglobulin G (38.1%). The autoantibody titers decreased with time and were comparable to the control values 16 weeks after treatment in both groups. Total serum levels of immunoglobulin G and M were high before treatment, but immunoglobulin M levels decreased significantly in week 8 during treatment with danazol, whereas C4 levels increased and C3 levels decreased with danazol. CONCLUSION: Danazol has an inhibitory effect on the autoimmunologic response associated with adenomyosis.

[Application of CT simulation system to stereotactic radiosurgery--experimental study in phantoms].

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.

[Histopathological study of the esophageal injury induced by high-dose-rate intracavitary irradiation].

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.

[Clinical results of N0 tongue cancer treated with interstitial brachytherapy and management of occult cervical node metastases].

One hundred patients with T1-2NO squamous cell carcinoma of the oral tongue were treated with interstitial brachytherapy at the Hyogo Medical Center for Adults between 1962 and 1983. These patients were followed for more than two years. The cumulative five-year survival rate was 89% in T1N0 and 66% in T2N0. The relapse-free survival rate was 88% in T1N0 and 51% in T2N0. The two-year local control rate in the primary site was 100% in T1N0 and 73% in T2N0. Cervical node metastases developed in 41% (T1N0: 33%, T2N0: 43%) of the patients. The five-year survival rate of the patients with subsequent cervical node metastases was 42%, while that of patients without subsequent cervical node metastases was 92% (p less than 0.001). Twenty-seven patients also received prophylactic neck irradiation (average dose: 33.8 Gy). In patients treated with prophylactic neck irradiation, the rate of subsequent cervical node metastases was 37% and the cumulative five-year survival rate was 62%. In the patients without prophylactic neck irradiation, these figures were 41% and 73%, respectively. There was no statistically significant difference between the two groups. Between 1984 and 1986, 28 patients with T1-2 N0 squamous cell carcinoma of the oral tongue were treated with interstitial brachytherapy. These patients were prospectively examined for the ability of chemotherapy to prevent the development of cervical node metastasis. In 13 patients treated with chemotherapy (CDDP 80 mg/m2 + PEP 6 mg/m2 x 5 days), the two-year local control rate was 90%, the incidence of cervical node metastases was 38% and the incidence of distant metastases was 15%.(ABSTRACT TRUNCATED AT 250 WORDS)

[Mass screening for uterine cancer during the last 10 years--its present situation and problems].

In Omagari city and five towns, 37,793 women were subjected to mass screening of uterine carcinoma from 1979 to 1988. The detection rate of uterine carcinoma was 0.058%. Initial screening rate was 41% 10 years ago, but in 1988, it was decreased to 18%. The peak age of the mass screening was 50-54 years old, but the carcinoma and dysplasia high degree were detected mostly in patients aged 60 years old or more. And the constitution of the age of mass screening in this study was inadequate for the screening of endometrial carcinoma. It is important to emphasize that older women (aged 60 or above) and nullipara should be encouraged to actively participate in the screening of cervical and endometrial carcinoma.

[Clinical evaluation of sodium alginate on oral mucositis associated with radiotherapy].

We evaluated the effect of sodium alginate on 39 patients with oral mucositis associated with radiotherapy. Sodium alginate was administered during radiotherapy to 17 patients with head and neck cancer. Compared with 22 patients without administration, sodium alginate reduced the pain and the erosion of oral mucosa significantly. Consequently the interval of radiotherapy was shortened. It is, therefore, expected that the effect of radiotherapy improves by the administration of sodium alginate.

[Absorption and excretion of cefotaxime and its levels in uterine arterial blood, female internal genital organ tissue and pelvic cavity fluid (author's transl)].

Following results were obtained from intravenous single administration of cefotaxime 2 g by measuring its levels in uterine arterial blood, elbow venous blood, ovary, oviduct, several sites in uterine tissue, and in the fluid excreted in the dead space formed by radical hysterectomy. (1) Uterine artery and elbow vein blood levels revealed marked increase immediately after administration followed by gradual reduction at slow rate. (2) Peak levels in female internal genital organ tissue were achieved 12 approximately 19 minutes after cefotaxime administration, and ranged between 5 to 8 mcg/g independently from measurement site. In cervix uteri, portio vaginalis high concentration of 4.9 approximately 5.7 mcg/g was achieved within ten minutes after drug administration. (3) In the fluid excreted in the dead space formed by radical hysterectomy cefotaxime levels were maintained around 15 mcg/ml level throughout 5 approximately 6 hours following its administration, and gradually decreased at slow rate later.