Plasma exchange in a patient with postpartum HELLP syndrome.

The case of a patient with HELLP syndrome, who was unresponsive to supportive management but successfully treated with plasma exchange, is presented. The significance of plasma exchange in the treatment of HELLP syndrome is discussed.

Detection of hepatitis C virus core protein in the glomeruli of patients with membranous glomerulonephritis.

Two Japanese patients suffered from membranous glomerulonephritis associated with hepatitis C virus (HCV) infection. Renal histologic changes were characterized by granular deposits of IgG and C3 along the capillary wall and numerous subepithelial deposits in glomeruli. Hypocomplementemia was present in one patient, but both cryoglobulins and rheumatoid factors were absent. HCV RNA was detected in both their sera by RT-PCR, both free and in the form of circulating immune complexes. The HCV core protein was found in the glomeruli from both patients by indirect immunofluorescence. These results suggest that in some patients chronic HCV infection causes membranous glomerulonephritis through immune complex deposition involving HCV proteins.

Carboplatin-based chemotherapy in patients undergoing hemodialysis.

In the present study, we investigated the pharmacology of carboplatin in two patients with chronic renal failure undergoing hemodialysis. In Case 1, squamous cell carcinoma of the epipharynx was treated with 265 mg/m2 of carboplatin alone. In Case 2, adenocarcinoma of the lung was treated with 300 mg/m2 of carboplatin in combination with 50 mg/m2 of etoposide. All agents were injected intravenously. Hemodialysis was initiated 30 minutes after carboplatin administration. Most platinum was excluded by hemodialysis in a pattern similar to that in patients with normal renal function. These observations suggest that carboplatin-based chemotherapy can be considered as a treatment modality for malignant neoplasia in patients with chronic renal failure undergoing hemodialysis.

Thymic carcinoma treated with intensive chemotherapy and radiation.

A 48-year old male presented with undifferentiated thymic carcinoma without distant metastasis. The patient was treated with intensive systemic chemotherapy with cisplatin, vincristine, adriamycin and etoposide, intrapleural instillation of adriamycin and OK-432, intrapericardial instillation of mitomycin C and subsequent radiation to the mediastinum. The combined treatment resulted in regression of the primary tumor and disappearance of pleural effusion and pericardial effusion. Nevertheless, the patient died 18 months after the initiation of chemotherapy.

Dose-intensive chemotherapy with cisplatin, vincristine, doxorubicin and etoposide against lung cancer: a pilot study.

We carried out the present study for the purpose of investigating the toxicity and efficacy of dose-intensive chemotherapy (Tokushima-CODE; T-CODE) against advanced lung cancer. Ten patients (8 with small-cell lung cancer and 2 with non-small-cell lung cancer) received chemotherapy consisting of cisplatin (27 mg/m2 on days 1-3), vincristine (0.7 mg/m2 on days 1 and 8), doxorubicin (40 mg/m2 on day 1) and etoposide (133 mg/m2 on days 1-3). Recombinant granulocyte-colony stimulating factor (75 micrograms/body on days 4-15) was injected subcutaneously. Nine patients had measurable lesions, and they all experienced partial responses. WHO grades 3 and 4 leukopenia was found in 7 out of 10 patients; thrombocytopenia (grades 3 and 4) was seen in 5 out of 10 patients during the first cycle. These results suggest that T-CODE chemotherapy is a promising induction chemotherapy.

[Two cases of membranous glomerulonephritis associated with hepatitis C virus infection].

Although the occasional occurrence of glomerulonephritis associated with hepatitis C virus (HCV) infection has been reported recently in the literature, the type described has been mainly membranoproliferative glomerulonephritis (MPGN); membranous glomerulonephritis (MGN) is very rare. In this paper, two cases of MGN associated with HCV infection are reported. Case 1 was a 56-year-old male who had positive HCV Ab and HCV RNA. The diagnosis of chronic active hepatitis was verified by liver biopsy. Laboratory data showed proteinuria (5g per day), hematuria and hypocomplementemia by hemolytic assay. Renal biopsy led to the diagnosis of MGN in stage II. The patient was treated with interferon alpha for 6 months, resulting in improvement of hypocomplementemia, transient reduction of GOT and GPT during the course of treatment. The GOT and GPT were aggravated again after the completion of therapy. No improvement was seen in proteinuria and hematuria, and HCV Ab remained positive. Case 2 was a 69-year-old male who had positive HCV Ab and HCV RNA, and had normal liver function. Subsequently, his GOT value was slightly elevated. Proteinuria (2g per day) was demonstrated. The diagnosis of MGN in stage II was made on the basis of renal biopsy. The clinical characteristics of these two cases suggest that MGN is a type of glomerulonephritis associated with HCV infection.

Intravascular bronchioloalveolar tumor with skin metastases.

Intravascular bronchioloalveolar tumor (IVBAT) is a rare pulmonary tumor that occurs in the younger age groups. In the present article, we describe a patient who manifested systemic growth after the resection of the primary tumor. Skin metastasis, which has never been reported, is histologically examined.

[Combination chemotherapy with carboplatin and etoposide against lung adenocarcinoma in a patient undergoing hemodialysis: a case report].

A 60-year-old male with chronic renal failure undergoing hemodialysis was treated with combination chemotherapy with carboplatin and etoposide against stage IV adenocarcinoma of the lung. Three hundred mg/m2 of carboplatin on day 1, and 50 mg/m2 of etoposide on days 1 and 3 were injected intravenously before hemodialysis. Pharmacokinetic results revealed that carboplatin was dialyzed. No severe side effects were observed. These observations suggest that combination chemotherapy with carboplatin and etoposide seemed to be applicable to the patients with chronic renal failure undergoing hemodialysis.

Comparison of cisplatin plus vindesine with cisplatin plus mitomycin C for treatment of advanced non-small-cell lung cancer. The Eastern Shikoku Lung Cancer Chemotherapy Group.

Seventy-six patients with advanced non-small-cell lung cancer were randomly allocated to two groups and treated with cisplatin (CDDP; 80 mg/m2 on day 1) plus either vindesine (VDS; 3 mg/m2 on days 1 and 8) or mitomycin C (MMC; 8 mg/m2 on days 1 and 8) every 3-4 weeks. The objective response rates were 26% (10/38) for CDDP plus VDS and 32% (11/34) for CDDP plus MMC; the corresponding response rates in patients with adenocarcinoma were 7% (1/14) and 43% (6/14), respectively. The median survival times of patients treated with CDDP plus VDS and CDDP plus MMC were 33 and 30 weeks, respectively, the difference in survival times in the two groups not being significant. There was no significant difference in toxic effects in the two groups except that alopecia and leukopenia were more frequent in patients treated with CDDP plus VDS.

[A case of gold-induced pneumonitis showing a positive reaction in the drug lymphocyte stimulation test (DLST) for gold].

A case of acute interstitial pneumonia developing during gold therapy is reported. A 67-year-old female with rheumatoid arthritis for about twenty years who received a total dose of 80 mg of gold thiomalate (Shiosol) for about two months, developed high fever and dry cough. Exertional dyspnea developed and chest roentgenogram showed diffuse small nodular and reticular shadows. RA and RAPA tests were positive. Drug lymphocyte stimulation test (DLST) for Shiosol was positive. The dyspnea resolved on administration of methylprednisolone. Chest roentgenogram and CT-scan showed improvement. A total dose of 80 mg of gold thiomalate, as administered in this case, is the minimum dose previously reported in Japan. It has been recently reported that allergic reaction is the mechanism of gold lung. In the present case, positive DLST indicated the existence of many activated lymphocytes, and was very useful in the diagnosis of gold lung.

Alternating chemotherapy with cyclophosphamide/adriamycin/vincristine (CAV) and cisplatin/etoposide (PVP) against small cell lung cancer. Eastern Shikoku Lung Cancer Chemotherapy Group.

Seventy-four confirmed small cell lung cancer (SCLC) patients received alternating combination chemotherapy with CAV and PVP. The CAV comprised of cyclophosphamide 800 mg/m2 on day 1, adriamycin 50 mg/m2 on day 1 and vincristine 1.4 mg/m2 on day 1, administered every 3-4 weeks. The PVP comprised cisplatin 80 mg/m2 on day 1 and etoposide 75 mg/m2 on day 1-5 administered every 3-4 weeks. Of these 74 patients, 63 (85.1%) achieved complete or partial responses with 16 (21.6%) obtaining a complete response. The median survival time was 13.2 months: 10.4 months in patients with extensive disease (ED), 16.3 months in those with limited disease (LD). A three-year disease-free period was achieved in eight patients (11.2%: 4.8% with ED, 16.8% with LD). The median duration of response was 28.3 weeks: 20.1 weeks with ED and 44.0 weeks with LD. The most commonly encountered side effects were nausea, vomiting, alopecia and myelosuppression but all were tolerable. We consider CAV-PVP to be an effective combination regimen for treating SCLC.

[A case of intrapulmonary lymph node simulating small carcinoma of the lung].

A 48-year-old male was admitted for further examination of a coin lesion with a diameter of 8 mm seen on chest X-ray. The patient was a heavy smoker and his serum level of CEA was elevated to 29.8 ng/ml. Since the broncho-fiberscopic examination was not able to yield a definitive diagnosis, an operation was performed as lung cancer was suspected. According to the histological examination, the small nodule was diagnosed as an intrapulmonary lymph node with anthracosis and silicotic nodules. A review of the limited number of case reports shows that men are more prone to intrapulmonary lymph nodes, and that the patients were all smokers but not necessarily with occupational experience of exposure to silica.

Effect of retinoic acid on proliferation and differentiation of cultured chondrocytes in terminal differentiation.

We obtained terminally differentiated chondrocytes in monolayer culture from chick embryonal growth plates, and examined the effect of retinoic acid on these cells. The cells treated with retinoic acid ceased type X collagen synthesis and showed decreased calcium incorporation into cell layers. Retinoic acid tended to stimulate proliferation of the cultured chondrocytes. It also increased DNA accumulation dose-dependently in the range from 1 nM to 1 microM. DNA synthesis in the growth phase and confluency was stimulated within 10 h after addition of 0.1 microM retinoic acid. [3H]Retinoic acid binding, which was inhibited by simultaneous addition of excess unlabeled retinoic acid, was detected in both the cytosolic and nuclear fractions of the chondrocytes. The retinoic acid binding capacity of the nuclear fraction was increased by pretreating the cells with retinoic acid. These results indicate that retinoic acid binds to both the cytosolic and nuclear fractions of cultured chondrocytes, and induces their proliferation and dedifferentiation.

Protein components of bronchoalveolar lavage fluids from non-smokers and smokers.

The protein components in concentrated bronchoalveolar lavage fluids (BALFs) from 10 healthy smokers and 10 non-smokers were analysed, using a differential quantitative method to measure bronchial secretory IgA(sIgA). In 3 volunteers the effect of increasing the volume of lavage fluid was also examined, indicating an increased recovery of each protein component but no change in the ratio of the different proteins. Albumin (Alb), alpha 1-antitrypsin, IgG and sIgA were consistently found, and IgE, C3-activator and C4 were sometimes found in BALFs, whereas, characteristically, IgM could never be detected. IgG/Alb ratio was not different from the serum value, reflecting passive transudation of IgG from the serum. However, some bronchial IgG could also be produced locally, especially in smokers, because their bronchial IgG/Alb ratio was significantly higher than in non-smokers. For IgA/Alb ratio, BALFs values were much higher than in serum, implying that most of the bronchial IgA was synthesized locally. In smokers, the amount of bronchial IgA tended to be decreased, suggesting that cigarette smoking suppresses bronchial IgA production and, hence, disturbs the local immunity of the lung.

Secretory-component-producing lung cancer with hypergammaglobulinemia of secretory IgA.

Studies were made on a case of well-differentiated adenocarcinoma of the lung in which the serum levels of secretory IgA (sIgA) were very high. Immunofluorescent studies showed that secretory component (SC) was found to be diffusely distributed in cancer cells. The SC was detected in the supernatant of homogenates of cancer tissues from the primary site and lymph node with metastases. The SC extracted from cancer tissue and purified colostral SC were antigenically identical. The authors conclude that the adenocarcinoma cells produced SC and secreted it into the bloodstream and that the binding of SC with polymeric IgA resulted in the hypergammaglobulinemia of sIgA. This appears to be the first reported case of SC-producing lung cancer. The authors' findings suggest that the high serum levels of sIgA in cancer patients may be due to the production and secretion of SC by tumor cells themselves rather than the reabsorption of intraluminal sIgA into the circulation through a damaged epithelium.