Laparoscopic cholecystectomy and the "soft trocar".

We have devised a new "soft trocar" for laparoscopic surgery. This translucent trocar, made of silicon, has a flexible sleeve that permits a curved instrument to pass through. Eighteen patients underwent laparoscopic cholecystectomy with the use of the soft trocar. There were no complications related to its use. The soft trocar is useful during laparoscopic cholecystectomy because it is radiolucent, a curved forceps can be inserted, and it is potentially less traumatic to the abdominal viscera than a standard trocar.

[Pleuroperitoneal shunt for malignant pleural effusions].

The malignant pleural effusion was introduced into the abdominal cavity by the manual compression of a pleuroperitoneal shunt tube, which was indwelt in the subcutaneous tissue of the lateral chest under local anesthesia. Seven patients having malignant pleural effusion, due to lung cancer in 4 and breast cancer in 3, were used as subjects. This technique caused no serious complications. Retention of pleural effusion was markedly reduced in all of the 7 patients. Three patients, whose performance status (P.S.) was preoperatively determined to be 3 or 2, could be discharged during early periods. This technique seemed to be highly feasible in these patients, but not in those having P.S. of 4. Since peritoneal dissemination of the tumor was seen in 1 of 3 patients examined by autopsy, there is a possibility that this technique might have contributed to spread and scattering of tumor cells in the peritoneal cavity. These results suggested that this technique is useful therapeutic means for the treatment of patients in whom hospitalization is necessary due to the presence of malignant pleural effusion, while this technique involves the risk of artificial induction of peritoneal dissemination of tumor cells. Therefore, the application of this technique should be decided based on the prognosis of each patient.

Accumulation of iodine-131 and technetium-99m pertechnetate in thyroid carcinoma.

Carcinoma of the thyroid is usually delineated as a cold defect on images with radioiodine and Tc-99m per-technetate. However, several cases that showed an accumulation of Tc-99m pertechnetate in thyroid carcinoma or in their metastases, but did not show any accumulation of radioiodine, have been reported. This paper presents a rare case of an advanced follicular adenocarcinoma of the thyroid that accumulated both Tc-99m pertechnetate and I-131. In this 41-year-old male patient, there were two primary foci in the thyroid; one occupied the whole left lobe with extension to the mediastinum and the other located in the lower part of the right lobe. In addition, there was a lymph node metastasis in the upper mediastinum adjacent to the left lobe. On images with both I-131 and Tc-99m pertechnetate, the tumor in the left lobe and the metastatic lymph node were delineated, but the tumor in the right lobe was not. Accumulation of Tc-99m pertechnetate in the lower part of the tumor of the left lobe was more distinct than that of I-131. Therefore, it is considered that despite similar histologic findings the trapping ability of the cancerous tissue differed from area to area.

[Experimental and clinical study on endocrine therapy of breast carcinoma, with special reference to the nuclear estrogen receptor].

The effects of hormones on growths and estrogen receptor (ER) processing were investigated on human breast carcinomas. Two human breast carcinomas, Br-10 (ERC +,ERn-,PgR-) and MCF-7 (ERc +,ERn +,PgR +), serially transplanted into nude mice were used for the experiments. The tumors were treated with estrogen (E) and/or progesterone (P) or tamoxifen (TAM). Although the growth of Br-10 was enhanced by EP and arrested by TAM, ER processing which was observed by E and EP was also observed temporarily by TAM in the early stage, however it was suppressed subsequently. The growth of MCF-7 was dependent on E and the suppression of ER processing was observed in MCF-7 which was transplanted into nude rats and maintained without hormonal treatment. Accordingly, it was suggested that ER processing could be altered by changes in hormonal environment of hosts. ER translocation by priming the exogenous estrogen in vitro was studied in clinical cases. Whereas ERn was detected in 3 out of 20 cases, ER processing was observed in 10 out of 17 ERc positive breast carcinomas (58.8%) and none observed in 3 ERc negativities.

Combined cytotoxic and endocrine therapy for human breast carcinoma (Br-10) serially transplanted into nude mice.

Cytotoxic and endocrine therapy on a human breast carcinoma (Br-10) serially transplanted into nude mice was given with reference to the sequence of drug administration. Mitomycin C (MMC) was combined with 2.5 mg/kg of tamoxifen (TAM). MMC was dissolved in 0.2 ml of physiological saline and administered intraperitoneally once weekly. TAM was dissolved in 0.1 ml of sesame oil and administered intramuscularly twice weekly. Both drugs were administered in the reverse sequence for 2 or 3 weeks. Cytosol estrogen receptor (ERc), nuclear estrogen receptor (ERn) and progesterone receptor (PgR), and 3H-thymidine uptake labeling index (L.I.) were assayed after the treatment. When 1.5 mg/kg of MMC was combined with TAM, statistically significant differences were nil between the different sequential administrations. When the MMC administration was reduced to 0.75 mg/kg and 2 weeks, respectively, the MMC----TAM sequence was more effective than the reversed sequential administration. MMC preserved ERc and depressed L.I. to almost half of that of the control tumor. TAM generated the ER systems and slightly depressed L.I. These different modes of action between MMC and TAM on ER systems and L.I. may explain the antitumor effects of different sequential administrations.

Human breast carcinoma (MCF-7) serially transplanted into nude mice.

The tumor cells (0.5 ml, 1 X 10(7) of MCF-7 line were inoculated into the subcutaneous tissue or intraperitoneum of female BALB/c nude mice. Primarily transplanted mice were treated with 17 beta-estradiol dipropionate (E2) in a dose of 5 mg/kg and 17 alpha-hydroxy progesterone caproate (Pg) in a dose of 250 mg/kg once a week. After the transferable strain was established, tumors were transplanted into female and male mice treated with E2, Pg, and E2 + Pg. The tumors treated with E2 or E2 + Pg grew exponentially while tumors in the other group regressed. Pg was assumed to play some role in the growth of MCF-7, in the presence of estrogen. Although cytosol estrogen receptors (ERc), nuclear estrogen receptors (ERn), and progesterone receptors (PgR) were detected by dextran coated-charcoal method and exchange assay in the growing tumors, ERn and PgR of regressing tumors was usually negative. This MCF-7 strain in nude mice may be a promising animal model for studying chemo-hormone therapy for human breast carcinomas.

[Epidemiologic study of breast fluid in Japanese women].

Breast fluid was collected from 805 Japanese women using a negative-pressure breast-pump procedure. All subjects were non-lactating; there were 275 breast cancer patients and 530 healthy women. Women who secreted 20 microliters or more were classified as "secretors" (290/805, 36%); those who secreted less than 20 microliters to as "non-secretors". Breast cancer patients showed a significantly higher incidence of secretion, particularly in the diseased breast, than healthy women. Among secretors, the risk for breast cancer was high in those with earlier menarche, unmarried women, those with a smaller number of pregnancies and children and those with older age at their first delivery.

[Immunological competence of nude mice on the growth of transplantable human tumors--with reference to natural killer cells].

Influences of natural killer cells on the transplantable human tumors was evaluated by using anti-asialo GM1 antibody. Two human gastric adenocarcinomas designated as St-4 (poorly differentiated) and St-40 (well differentiated) were inoculated into nude mice. The effects of anti-asialo GM1 antibody were assessed in terms of tumor doubling time (Td) and 3H-thymidine (3H-TdR) uptake labeling index (L.I.). Whereas the Td of St-4 was significantly shortened by administration of anti-asialo GM1 antibody, no noticeable changes were observed in St-40. This enhanced growth of St-4 was also supported by the elevation of L.I. both in flashing and repeating methods. On the other hand, as the repeated L.I. of St-40 was almost 100% in control tumors, repeated L.I. was not increased by the administration of anti-asialo GM1 antibody. It was supported that natural killer activity of nude mice regulated the growth of transplantable human tumors concerning with the growth fractions.