[Small cell lung cancer with acute monocytic leukemia after combined chemotherapy including etoposide].

Small cell lung cancer (stage IIIB) developed in a 61-year-old woman. She was treated with chemotherapy in which the cumulative dose of carboplatin was 662 mg/m2 and that of etoposide was 2,000 mg/ m2, and with concurrent irradiation in which the total dose of X-rays was 44.8 Gy. The response to chemotherapy and irradiation was very good. Radiation pneumonitis developed after discharge, but it resolved after steroid therapy. Nine months after the diagnosis of lung cancer the patient was readmitted because of bleeding and leukocytosis. Acute monocytic leukemia (M5a) was diagnosed after examination of a bone-marrow aspirate. The patient was treated with chemotherapy, but she died of severe bone-marrow suppression and multiple organ failure 3 months after the diagnosis of acute monocytic leukemia. Although chromosome analysis could not be done, we strongly suspect that this leukemia was induced by etoposide, because of the clinical course.

[A case of leiomyosarcoma of the esophagus].

A 67-year-old woman was admitted on June 21, 1990 because of an abnormality on chest roentgenogram, a three-month history of palpitations on exertion, and a 2 kg weight loss. Chest roentgenogram revealed a huge mass in the posterior mediastinum. The results of needle aspiration cytology from the mass and celiac angiography were suggestive of leiomyosarcoma of the esophagus. The patient underwent tumor enucleation. The tumor originated from the lower-portion of the thoracic esophagus, measured 23 x 13 x 13 cm, and weighted 1110 g. The tumor was diagnosed as leiomyosarcoma histologically. Esophageal leiomyosarcoma is a very rare malignant tumor. The present case had no history of dysphagia in spite of the large tumor size.

[A case of malignant pleural mesothelioma presenting as pneumothorax].

The patient was a 51-year-old woman who had no history of asbestos exposure and showed left pneumothorax with a small amount of pleural effusion. On admission to our hospital, she showed clinical and laboratory data similar to that of spontaneous pneumothorax except for a high concentration of hyaluronic acid in pleural fluid. After treatment of pneumothorax, pleural effusion appeared to decrease on chest X-ray. After 3 months, however, pleural effusion again increased, in spite of the improvement of pneumothorax. The patient received open lung biopsy and the histological examination showed mixed type malignant pleural mesothelioma.

Chronic bronchopneumonia with recurrent hemoptyses and resultant severe anemia.

A female patient, 69 years old, was hospitalized because of a 2-year history of recurrent hemoptyses resulting in severe anemia. X-ray examination of the chest showed a mass lesion in the right lower lung field, which had grown over the preceding 2 years. Bronchographic, arteriographic and CT examinations excluded the possibilities of bronchiectasis, pulmonary A-V fistula or sequestration. Histological examination following right lower lobectomy revealed no evidence of neoplasms or tuberculosis, fungal and parasitic infections but showed a predominant mononuclear cell infiltration and abundant small vessels in the affected small bronchi, and peribronchiolar and adjacent alveolar regions. To our knowledge, no case with chronic bronchopneumonia accompanied by such massive hemoptyses, as seen in this case, has been reported to date.

[Association of various cardiac parameters and signal-averaged electrocardiographic late potentials in patients with myocardial infarction].

UNLABELLED: After the amplification and filtration of the surface ECG, late potential signal (LP) in QRS termination was determined. Subjects were 52 patients who experienced acute myocardial infarction within 5 years and measurement was undertaken 70 times. 271 pulses (average) were measured using the Model 101 PC system (ART Co, Ltd) with 40-250 Hz filter. Relationship of LPs and ventricular tachyarrhythmia, LPs and left ventricular function were studied according to the ejection fraction (EF) of left ventricle (= index of left ventricular function) and maximum value of CPK (CPKmax) in acute phase. The patients with bundle branch block, atrial fibrillation and noise above 1.0 microV were excluded. RESULTS: (1) Higher incidence of LP was shown in patients with triplet or more runs of ventricular tachycardias. (2) Higher incidence of LP was shown in patients with lower EF and higher CPKmax. Above results showed that non-invasive and simple recording of LPs in patients with myocardial infarction was useful in the discrimination of the patients with ventricular arrhythmia and presumption of left ventricular function.

A hybrid bioartificial liver composed of multiplated hepatocyte monolayers.

Monolayer cultures of hepatocytes were shown to have good function when compared with suspended cells. The authors manufactured a new hybrid artificial liver containing hepatocyte monolayers and evaluated its function. Hepatocytes isolated from an adult dog liver were cultured on collagen coated borosilicated glass (10 X 20 X 0.04 cm). A long-stroke artificial liver module was constructed by stacking 200 glass plates bearing hepatocytes, which were viable and functioned well during 4 weeks in perfusion culture; glyconeogenesis = 110 ng/micrograms DNA/min, urea synthesis = 3.6 ng/micrograms DNA/min and albumin synthesis = 29 micrograms/10(6) cells/day at the 5th day of perfusion. The levels were maintained for 2 weeks. The new device was applied to anhepatic dogs (Group 3) and compared with untreated (Group 1) and plasma exchange dogs (Group 2). The survival times were 21.3 +/- 5.6 hours in Group 1 (N = 6), 27.8 +/- 4.0 hours in Group 2 (N = 3), and 55.0 +/- 10.3 hours in Group 3 (N = 4). The longest survival was 65 hours. Serum ammonia increased to over 2,000 micrograms/dl after 12 hours in Groups 1 and 2, but remained under 400 micrograms/dl in Group 3. This new type of hybrid system may be a pilot design for the complete artificial liver.

[Pharmacokinetic and clinical studies on latamoxef in the field of obstetrics and gynecology].

Latamoxef (LMOX) 1 g was administered twice daily for 5 days to patients undergoing operation for myoma uteri and the time course of tissue concentrations of the drug and the prophylactic effect of the treatment on postoperative infection were studied. 1. Area under concentration-time curve (AUC) of LMOX was the highest in the perimetrium (45.3%), followed by the cervix uteri (39.2%), endometrium (35.9%), oviduct (35.1%), myometrium (29.5%), and ovary (24.4%). 2. Cmax was the highest in oviduct (46.9 micrograms/g), followed by Cmax's in perimetrium (44.2 micrograms/g), cervix uteri (35.8 micrograms/g), myometrium (26.9 micrograms/g), endometrium (25.6 micrograms/g), and ovary (24.3 micrograms/g). 3. Serum half-lives were T1/2(alpha) = 0.27 hour and T1/2(beta) = 1.81 hours. 4. Prophylactic efficacy against postoperative infections was 94.3%, and febrile morbidity was 5.7%. The preoperative and postoperative laboratory tests did not show appreciable changes, no adverse reaction was observed. In the present study, LMOX showed good transfer into gynecological tissues, suggesting its very high usefulness in the treatment of infection and in the postoperative management.

Lysozyme secreting tumor: a case of gastric cancer associated with myelofibrosis due to disseminated bone marrow metastasis.

One patient with gastric carcinoma and secondary myelofibrosis due to disseminated bone marrow metastasis had markedly elevated lysozyme (LZM) levels in serum and urine with the intense presence of LZM within tumor tissues. It is considered to be a case of gastric carcinoma with LZM secreting functional capacities. To date, there were many reported cases to verify the LZM positive cells by LZM staining in the tissue of gastric carcinoma and to demonstrate the elevated serum levels of LZM in malignant tumor bearing patients, whereas no papers to disclose the elevated levels of LZM in serum and urine originated from the productions and secretions of gastric carcinoma cells. So, this report might be the first reported case of LZM secreting tumor verified by LZM staining of carcinoma cells except for haematological malignancies such as acute monocytic leukemia or myelomonocytic leukemia.

[Pharmacokinetic studies on cefmenoxime. Distribution into the uterus and intrapelvic genital organs].

Concentrations of cefmenoxime (CMX) in peripheral venous serum, uterus and intrapelvic genital organs were determined by bioassay. The obtained results are summarized below. When 1 g of CMX was administered by an intravenous injection, peak concentrations in various tissues of female genital organs were as follow: 17.4 and 46.8 micrograms/g in ovary and oviduct, respectively, and from 28.2 to 43.8 micrograms/g in other genital organs. These concentrations of CMX were maintained at higher level than minimal inhibitory concentrations against E. coli, Bacteroides and other organisms. In these studies, CMX showed a satisfactory clinical efficacy and a potent antibacteriological effect in the treatment of infections in the field of obstetrics and gynecology.

[The statistical evaluation of the female breast cancer detected by mass screening in Hokkaido].

In Hokkaido, 113, 612 women were subjected to mass screening of breast cancer from 1973 to 1983. Out of them, 74, 285 (56.3%) were examined once and the remainder twice or more: 4,798 (4.2%) were advised to receive further precise examinations and 99.8% of them underwent the second examination. Breast cancer was detected in 377, in which 291 (77.2%) were detected by the first examination and 33 (3.8%) were so-called "interval cancer" with the mean interval of 19.3 months. The detection rate was 0.3%. Histologically non-invasive cancer was seen in 26 (6.9% of 377). Despite a recent significant increase in detection rate of the earlier stage of breast cancer, the present study showed no evidence of a decrease in advanced cancer. The prognosis of the patients who had curable operation revealed 86.9% in 5 year survival rate and 40% in 10 year survival rate.