Application of PDT for Uterine Cervical Cancer.

We have been performing PDT using Excimer Dye Laser (EDL) or YAG-OPO laser, a type of low power laser, both of which have a considerably higher degree of tissue penetration even when compared to PDT using Argon Dye Laser (ADL).PDT is a relatively simple procedure without any bleeding and does not require anesthesia since it causes no pain. PDT is performed 48 h after intravenous injection of 1.5-2.0 mg/kg of PHE (Photofrin((R))). Precise spot irradiation is possible using a colposcope with an optical laser path. We also use a cervical probe which enables photoirradiation of the entire cervical canal.We have performed PDT on 131 cases (95 CIS, 31 dysplasia, 1 vulval dysplasia (VIN), 3 squamous cell carcinoma, microinvasion, and 1 CIS + endocervical adenocarcinoma, microinvasion). Of these cases, 127 became CR (96.9%). The first CR case was 10 years ago and no recurrence has been observed yet.PDT is extremely effective to preserve fertility. Except for sensitive reactions to sunlight, there are no noticeable side effects or difficulties related to pregnancy or delivery. We expect that in the near future PDT will be performed using diode lasers and without hospitalization due to new photosensitizers which have shorter retention times.

[Cancer-associated gene abnormalities and chemosensitivity].

One of the most important clinical issues in cancer chemotherapy is the presence of intrinsic resistance or the appearance of acquired resistance against chemotherapy. As for intrinsic resistance, we had to perform direct chemo-sensitivity testing, or had to rely on the knowledge empirically acquired from randomized clinical trials. However, molecular or genetic markers associated with chemo-sensitivity have been reported recently. For example, inactivation of p53 or GML gene has been reported to be associated with chemo-resistance. Overexpression of topo-isomerase I has been reported to be associated with chemo-sensitivity to Topo I inhibitor. Overexpression of Thymidine Phosphorylase has been found to be associated with chemo-sensitivity to prodrug of 5-FU. By checking the status of such chemo-sensitivity markers prior to chemotherapy, it would be possible to predict the chemotherapeutic effect and even the necessity of the chemotherapy in the near future. In this article, we review the chemo-sensitivity markers reported so far, and methodology contributing to the discovery of new chemo-sensitivity markers. As a clinical study, 11 cases of ovarian cancer with high sensitivity to cisplatin-based chemotherapy and 29 cases of ovarian cancer with chemoresistance were analyzed by Comparative Genomic Hybridization (CGH). Copy number decrease in Xp, and copy number increase in 19q were observed in 13, 12 out of 29 resistant cases (45, 41%) and zero, 1 out of 11 sensitive cases (0, 9%), suggesting that -Xp and +19q were likely to be a genetic event associated with intrinsic drug-resistance (p = 0.006, 0.05, respectively). This effort should contribute to the discovery of new chemo-sensitivity and resistance markers.

[Expression of glutathione S-transferase pi and numerical aberration of chromosome 11 in human ovarian cancer as a prognostic indicator].

In 33 patients with primary ovarian cancer who had not received any chemotherapy before surgery, expression of glutathione S-transferase pi (GST-pi) was studied immunohistochemically in relation to the response to chemotherapy with CDDP, and furthermore it was examined whether numerical aberration of chromosome 11 was available as a prognostic indicator. The obtained results were as follows: 1. Of 33 ovarian cancer tissue samples, 19 (57.6%) showed positive staining and 14 (42.4%) negative staining for GST-pi. 2. The 5 year survival rate of the patients with GST-pi positive tumors was significantly lower than that of those with GST-pi negative tumors (p < 0.01). 3. The frequency of detection of cells showing numerical aberration of chromosome 11 in tissues was significantly higher in ovarian cancers than in benign ovarian tumors and normal ovaries. 4. The 5 year survival rate of the patients with ovarian cancer in which the cells showing numerical aberration of chromosome 11 at 20% or more was significantly lower than that of those in which such cells were under 20% (p < 0.02). These results show that expression of GST-pi and numerical aberration of chromosome 11 in the tissues of human ovarian cancers are useful as prognostic indicators.

The population dilemma.

PIP: Technology and population rely on each other for sustenance and growth. Technology has helped produce more food, provide better health care, better communication, faster modes of travel, better consumer durables, greater amenities, and increased the quality of life for millions of people. There has been a price in terms of the widening gap between the technology of the developed and developing countries. There has also been rapid population growth that has resulted in a host of ills. Further, technology itself has produced toxic wastes and consumed a large amount of natural resources. This situation is easily seen as a dilemma between the limitless promises of technology and the limited resources created by large populations. The solution to the dilemma is sustainable development, a concept often talked about but seldom realized. The 90s will be a crucial decade for sustainable development as population is growing by 90 million/annum. 90% of the increase is occurring in developing countries. Within each country there is a trend towards urbanization. By 2000, 75% of Latin Americans, 42% of Africans, and 37% of Asians will live in urban environments. By 2050 there should be 100s of millions of migrants running from the slowly rising sea. The survival equation is sustainability S equals resources R time ingenuity 1 over population P. This is a conceptual equation, but it does illustrate that the impact of human ingenuity is just as important as resources. World commitment must come before any meaningful change will occur. The almost universal acceptance of human rights and fundamental freedoms exceeds the will to change in decision makers and expert consultants.^ieng

Women and population aging.

PIP: In 1985, there were approximately 427 million persons aged 60 and over in the world, accounting for about 9% of the world's population. By 2020, the elderly population will comprise 13% of the world's population and 70% of these people will live in developing countries. Governments and international agencies should increase their efforts and activities to improve care for the elderly within the family unit. The socioeconomic implications of aging are greater for females because of their higher life expectancy. In the year 2000, 11% of the world's female population will be aged 60 and over. By 2025, there will be 604 million elderly women in the world, 70% of whom will be living in developing countries, and among them, 70% in rural areas. An important issue requiring both research and policy attention is the interdependence among women's economic, health, and social concerns, which increase with age. The author calls for more specific policies that aim to eliminate discrimination against disabled persons, the elderly, and particularly elderly women. The author urges governmental and nongovernmental organizations to implement these recommendations: 1) promote research studies and the collection and analysis of information on the socioeconomic, health, legal, and demographic situation of elderly women; 2) promote awareness of elderly women's contribution to society; 3) eliminate discriminatory treatment of elderly women; 4) develop health promotion programs and services to meet elderly women's long-term care needs; 5) promote wider appreciation of continued participation of elderly women in social and cultural activities; 6) promote the development of elderly women's organizations and self-help groups; 7) promote and assure the participation of elderly women in the process of development; and 8) develop literacy programs and training programs for elderly women.^ieng