[FLEP therapy for advanced and recurrent gastric cancer].

The FLEP regimen (5-FU, LV, ETP and CDDP) is a combination chemotherapy administered regionally and systemically for the control of both local and disseminated disease in intra- and extra-abdominal regions in patients with advanced and recurrent gastric cancer. Sixty-one patients with advanced and recurrent gastric cancer were entered into this study. The treatment regimen consisted of 5-FU at 370 mg/m2 (days 1 to 5, i.v. 24 h); LV at a dose of 30 mg (days 1 to 5, i.v. bolus); and ETP and CDDP each at 70 mg/m2 (days 7 and 21, ia 2 h). This regimen was repeated every four weeks. The overall response rate was 36.1% (22/61) and the 50% and median survival times were 10.23 and 11.80 months, respectively. The adverse events were Grade 3/4 leukocytopenia (18.0%), Grade 3/4 thrombocytopenia (4.9%), Grade 3 nausea and/or vomiting (3.3%) and Grade 3 stomatitis (1.6%). Of the 17 NAC patients, the six curability B patients showed a statistically higher survival rate than the curability C and unresected patients. Based on the encouraging response rate and the improvement in prognosis, we recommend the FLEP regimen for patients with primary gastric cancer. Neoadjuvant chemotherapy using the FLEP regimen should be performed with curative resection as an objective.

[Neoadjuvant chemotherapy for advanced gastric cancer using FLEP therapy].

Combination chemotherapy with 5-FU, LV, ETP and CDDP (FLEP) for advanced gastric cancer uses a combination of regional and systemic delivery for the control of both local and disseminated disease in the intra- and extra-abdominal regions. We performed this regimen as neoadjuvant chemotherapy (NAC). Fifteen patients with unresectable primary advanced gastric cancer underwent FLEP. The treatment regimen was 5-FU at 370 mg/m2, LV at 30 mg/body (days 1 to 5, i.v. 24 h) and ETP and CDDP each at 70 mg/m2 (days 7 and 21, ia 2 h). This regimen was repeated every four weeks. The overall response rate was 46.7% (7/15), and the 50% and median survival times were 11.43 and 12.35 months, respectively. The adverse events were Grade 3 leukocytopenia, Grade 3 thrombocytopenia, and Grade 3 stomatitis in 20.0%, 13.3%, and 6.7% of the patients, respectively. The 50% and median survival time overall were 11.43 and 12.35 months, respectively. Of the 15 NAC patients, curability B patients showed a statistically higher survival rate than curability C and unresected patients. In conclusion, FLEP was effective for unresectable advanced gastric cancer.

[A case of lung metastasis from breast cancer successfully treated by FLEP (5-FU leucovorin, etoposide CDDP) combined arterial infusion chemotherapy].

A 33-year-old woman had undergone left mastectomy after diagnosis of breast cancer. One year after operation, multiple lung metastasis was confirmed by chest X-ray and CT scan. The patient received 6 courses of cyclophosphamide, epirubicin, and 5-FU (CAF) combined chemotherapy. However, the lesions were increased and the result of this chemotherapy was judged to be "progressive disease" (PD). A catheter was placed in the thoracic aorta, and FLEP combined intraaortic infusion chemotherapy was performed. The patient received 4 courses of 5-FU (325/mg/m2/day, civ, on day 1-5), leucovorin (30 mg/body/day, iv, on day 1-5), etoposide (60/mg/m2/day, ia, on day 7 and day 21), cisplatin (60/mg/m2/day, ia on day 7 and 21) every 4 weeks. The multiple lung metastasis almost disappeared on chest examination, and found to be less than 1 cm in diameter on CT scan. This result suggests FLEP combined chemotherapy is effective as a second-line treatment of recurrent breast cancer.

A histopathological study of direct pulp capping with adhesive resins.

This study evaluated the histological pulp responses of four different adhesive resin systems placed directly on exposed pulp tissue. Gap formation between the respective resin and cavity walls was observed and correlated to the pulpal response. Occlusal cavity preparations creating mechanical pulp exposures were prepared in molars of wistar rats. Preparations were filled using one of the following resin systems: 1) Superbond C&B system, 2) Clearfil Liner Bond system, 3) Tokuso Light Bond system, and 4) Scotchbond Multi-Purpose One All system. Although there were no significant differences in the pulpal responses after 3 days, significant differences were observed after 7 days. Results showed that the Superbond C&B system induced only a slight initial reaction, while secondary dentin was observed at the 30-day postoperative evaluation period. The Clearfil Liner Bond system showed a slight initial reaction to the materials, but exhibited slight pulpal necrosis and formation of secondary dentin at the 90-day evaluation period. The Tokuso Light Bond and One All systems showed severe pulpal reactions at all evaluation periods with no formation of secondary dentin. Microleakage formation correlated with the histopathological responses. Superbond C&B exhibited no microleakage, and only slight microleakage was observed when the Clearfil Bond system was used. The Tokuso and One All systems exhibited a wide area of microleakage. Further in vivo study evaluating the clinical use of adhesive resins for pulp capping is necessary to determine which resin systems may be used for direct pulp capping without incurring severe damage to pulpal tissue.

The distribution of keratin type intermediate-sized filaments in so-called mixed tumour of the skin.

Epithelial cells can be distinguished from various non-epithelial cells by the presence of keratin-type intermediate-sized filaments, which can be detected by immunofluorescence microscopy, using antibodies to alpha-keratin. In the present study, two types of antibodies were obtained. One of them was specific for alpha-keratin (mol. wt. 49,000 to 69,000 daltons) in whole epidermis, and the other for alpha-keratin (mol. wt. 62,000 and 69,000 daltons) in prickle and granular cells but not in basal cells. Four cases of so-called mixed tumour of the skin were studied by immunofluorescence microscopy using these antibodies. Tumour cells nests of cuboidal and polygonal cells, tubular structures and keratinous cysts reacted with these antibodies, as did individually-dispersed tumour cells within the myxoid and chondroid matrix. These results indicate that all the tumour cells of the so-called mixed tumour of the skin are of epithelial origin. Differences in staining intensity between these tumor cells and their specificity for these two antibodies are discussed with reference to keratin differentiation in tumour cells.

A simplified method for studying fibrous proteins in psoriatic scales obtained by tape stripping.

Polyacrylamide gel electrophoretic investigations were carried out on solubilized proteins from psoriatic and normal stratum corneum obtained by adhesive tape stripping. The proteins in the scales adhering to the tape were solubilized by incubating the tape in 1% sodium dodecyl sulphate (SDS) solution. The electrophoretic behaviour of these solubilized proteins on SDS-polyacrylamide gel was compared with the alpha-fibrous proteins (keratin) of callus. The proteins isolated from callus of normal human heel showed six main bands which were similar to those of the keratin isolated by the 8 M urea-mercaptoethanol method. The lesional skin of forty-five psoriatic patients consistently showed nine main bands on polyacrylamide gels, but only two main bands were observed in the non-lesional, non-heel skin. Six of these nine bands had mobilities and relative intensities almost identical with those of alpha-keratin extracted by the mercaptoethanol method, but the other three bands had greater mobilities on the gels. These results suggest that this technique may have considerable potential for studying changes in alpha-keratin in patients with psoriasis and other disorders of keratinization.