A 6-month-old girl presented with an abdominal mass and high serum levels of α-fetoprotein. Computed tomography showed an extremely large tumor of the liver, which was diagnosed with open biopsy as a well-differentiated hepatoblastoma. Left hepatic lobectomy was performed after regional chemotherapy, including cisplatin, which was effective. The biopsy specimen was transplanted to a nude mouse, and a xenograft was successfully established. The xenograft maintained the characteristics of the original tumor with regard to cell structure and the high serum level of α-fetoprotein in both hosts. A part of the xenograft was subjected to methylthiotetrazole assay. Cisplatin was most effective, as it had been clinically. Xenografts may be useful for determining the chemosensitivity of hepatoblastoma.

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Detection of specific mRNA signals using reverse transcription linked with polymerase chain reactions (RT/PCR) requires a minimum of two oligonucleotides used as sense and antisense primers for PCR. Identification of the resultant RT/PCR products is usually accomplished by either verifying digestion into the correct fragment sizes from a predicted restriction site internal to the amplified sequence or by hybridization using an oligonucleotide probe complementary to a portion of the amplified product.
In this report we describe an instance in which RT/ PCR of mRNA from cell lines (human fibroblasts and vascular smooth muscle), which did not express a given gene (von Willebrand factor), led to spurious amplification of cDNA products that appeared to have the correct predicted size on agarose gel electrophoresis and that also gave positive hybridization to probes made from PCR primers used for amplification. Cell lines (human endothelial cells) that did express the gene, however, gave positive hybridization signals for a probe complementary to a third region internal to the amplified sequence. This probe did not show any false hybridization to the amplified DNA products from fibroblasts and smooth muscle cells. This example indicates that three determinants (sense and antisense primers and predicted product size) are not enough to identify a true mRNA signal by RT/PCR. A fourth determinant, such as an oligonucleotide probe, needs to be employed to definitively identify RT/PCR amplification products.

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To investigate the correlation between peripheral catecholamine levels and hypotension often encountered during hemodialysis, we measured blood pressure and plasma levels of norepinephrine (NE), epinephrine (E), and dopamine (DA) before, during, and after hemodialysis in patients with renal failure. Subjects included 37 patients with chronic renal insufficiency whose blood pressure increased, was stable, or decreased during hemodialysis.
Patients were then divided into three groups on the basis of changes in either systolic blood pressure (SBP) or diastolic blood pressure (DBP) . Changes in plasma catecholamine levels were investigated by comparing data in these increase, stable and decrease groups in both SBP-and DBP-based classifications. Blood was collected before, during, and after hemodialysis, and catecholamine levels were determined with high-performance liquid chromatography / electrochemical detection. Levels of NE tended to decrease during hemodialysis in the increase groups, did not change significantly in the stable groups, and increased, although not significantly, in the decrease groups, in about half of the patients in both the SBP- and DBP-based classifications. Levels of E and DA did not show any clear correlation with changes in blood pressure and tended to decrease during hemodialysis. Passage through the dialyzer decreased plasma levels of catecholamines by 48 % to 74 %. In summary, in spite of the transient removal of plasma catecholamines by hemodialysis, NE levels tend to decrease in patients in whom blood pressure increases during dialysis and remain stable in patients in whom blood pressure is stable or decreases. Our results suggest that the sympathetic nervous system is activated in response to blood pressure changes during hemodialysis.

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Fifty-one anterior cruciate ligament reconstructions were performed using the bone-tendon-bone method from April 1991 through March 1996. In these 51 cases floor plasty was not performed in 23 cases, of which 12 cases were judges to be failed ACL reconstructions because of instability of 3 mm or greater relative to the healthy knee and confirmation of rupture with arthroscopy. These 12 cases of failed reconstruction (in 2 men and 10 women) were 6 cases of femoral tunnel (notch), 1 case of femur-side K-screw tip, 3 cases that can be considered tibia tunnel remodeling, and 2 cases that can be attributed to the tibia-side K-screw.
To prevent these failures measures, such as thorough formation of the notch, posteriorly shifting the opening of the tibial articular facet tunnel hole, implementing floor plasty, and development of a non-tapered interference screw, should be considered.

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The aim of this study was to evaluate the combined antitumor effect of CGS16949A and 5-fluorouracil (5-FU) against human breast cancer cell lines. MCF-7, SK-BR-3, and MDA-MB-231 were cultured and measured with [³H] water assay and MTT assay. Three human breast cancer cell lines were treated with 10 nM CGS 16949A and 100μg/ml 5-FU. The aromatase activities (percent aromatase activity) of the three human breast cancer cell lines were significantly inhibited by CGS 16949A. In particular, combined treatment with CGS16949A and 5-FU inhibited aromatase activities more than did CGS 16949A alone. In two cell lines (SK-BR-3 and MDA-MB-231) inhibition rates increased with 5-FU in a dose-dependent manner, and, in particular, the combined antitumor effect of CGS 16949A and 5-FU against SK-BR-3 with the MTT assay was shown. To our knowledge, this is the first report of a combined antitumor effect of an aromatase inhibitor ( CGS 16949A) and 5-FU in three human breast cancer cell lines.

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Chemicaly-induced autochthonous colon cancer was used to examine the sensitivity of tumors to combined administration of cisplatin (CDDP) and UFT, a mixture of tegafur (1- ( 2-tetrahydrofuryl) -5-fluorouracil) and uracil. Thirty-four Sprague-Dawley rats received azoxymethane (7.4mg/kg) s. c. once weekly for 10 weeks to induce colon cancer. Twenty weeks after the start of carcinogen treatment, barium enemas were performed to visualize tumors. The animals were divided into three groups, which were subjected to the following treatments: group A, control; group B, UFT; and group C, UFT plus CDDP. After 5 weeks of treatment, barium enemas were repeated. A total of 92 tumors were found on necropsy, and the mean tumor incidence per rat was 4.4 in group A, 2.9 in group B, and 2.5 in group C. Tumor doubling times were available in 54 % (50/92) of tumors. The mean doubling time of 24 tumors in the control group was 19.0±8.4 (SD) days. Response was judged as effective when the doubling time exceeded 35.8 days, calculated from the mean + 2 SDs in the control group. The response rates in the UFT and the UFT plus CDDP groups were 25 % and 50 %, respectively. UFT in combination with CDDP showed synergistic antitumor effects in autochthonous colon cancer. The present autochthonous colon cancer system may be useful for the evaluation of single anticancer drugs and combined treatments.

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Purpose Although the role of pelvic lymphadenectomy in prostate cancer is mainly as a staging procedure, the relation between the status of the primary tumor and lymph node metastasis has not yet been fully investigated. We investigated this relationship. Methods From 1987 through 1994, we observed 30 patients with clinically localized cancer of the prostate who had undergone bilateral pelvic lymphadenectomy. Of the 30 patients treated, 13 had radical prostatectomy, 15 had cystoprostatectomy, 1 had modified exenteration, and 1 had total exenteration. Findings Of the 30 patients treated, 5 (16.7 %) were found to have lymph node metastasis. Observation of the frequency of nodal metastasis with clinical stage, degree of differentia-tion, and histopathologic stage revealed 2 patients (15.4 %) with stage B, 3 (20.0 %) with stage C, 3 (30.0 %) with moderate differentiation, 2 (18.2 % ) with poor differentiation, 3 (30.0 %) with pT3, and 2 (16.7 %) with pT4. In the 5 patients with positive nodes, the palpable tumor was confined to one lobe in 3 and was predominant in one lobe in 2. Of the 3 patients with unilobar involvement, 2 had metastases to only the ipsilateral node and 1 had metastases bilaterally. Both patients with palpable induration and distribution of tumor to predominantly one lobe had metastases to the ipsilateral nodes. Conclusion All patients with palpable tumor predominantly in one lobe had metastases to the ipsilateral nodes.

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To evaluate the possibility of limited surgery of early gastric cancer, 500 patients with solitary early gastric cancer were analyzed. Lymph node metastasis was found in 2 (0.8 %) of 260 patients with mucosal cancer, and 45 (18.8 %) of 240 patients with submucosal cancer. In early gastric cancer with lymph node metastasis, the primary tumor tended to be undifferentiated and large, especially in tumors of more than 2 cm in diameter. Tumors located on the greater curvature had a higher rate of lymph node metastasis than did tumors on the lesser curvature or the anterior wall.
On the basis of the results of this series, we propose that the decision of limited surgery for early gastric cancer should depend mainly on the depth of cancerous invasion, tumor diameter, and histologic type. First, tumors of less than 1 cm in diameter without ulcer and differentiated mucosal cancer 2 cm or less in diameter without ulcer can be treated with endoscopic surgery. If cancerous invasion is found in the submucosa or lymphatic vessels of the resected specimen, limited surgery should be performed after endoscopic surgely. Second, undifferentiated mucosal cancers 1 to 2 cm in diameter, submucosal tumors 1 to 2 cm in diameter, and mucosal tumors of more than 2 cm in diameter can be treated with limited surgery. Third, gastrectomy with D2 lymphandectomy is still indicated for submucosal cancer, if the diameter is greater than 2 cm.

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Many reports describing the utility of vancomycin against methicillin-resistant Staphylococcus aureus (MRSA) infection have been published, while there have only been a few concerning arbekacin (ABK), an aminoglycoside developed in Japan. In the present study, the efficacy of this drug was assessed in 11 patients with MRSA infections (2 with sepsis and 9 with pneumonia) who were admitted to the Emergency Center, Showa Universtiy Fujigaoka Hospital. ABK was administered by intravenous infusion over 60 minutes at doses of 50, 100, 200, and 400 mg 1 to 4 times daily, and blood was collected at various times after administration. ABK was found to be ineffective in all patients at doses of 50 and 100 mg, but was effective against pneumonia at a dose of only 200 mg. However, ABK was effective against both pneumonia and sepsis at a dose of 400 mg. We conclude that ABK has a dose-dependent anti-MRSA effect. When the postantibiotic effect, first-exposure effect, and other factors are considered, ABK is best administered once daily rather than in small, more frequent doses. However, with the once-daily regimen, therapeutic drug monitoring is necessary to prevent adverse reactions.

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An intrasplenic hemorrhage that mimicked mycotic aneurysm and was successfully treated with splenectomy' developed in a 40-year-old man who had been receiving hemodialysis for 4 years. The resected specimen showed a ruptured arterial wall and a large cavity containing a hematoma with microscopic abscesses in the congestive spleen. We describe this unusual complication of chronic hemodialysis and discuss the possible etiology.

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Mitochondrial encephalomyopathy is a general name for a group of myopathy associated with central nervous symptoms. For MELAS (mitochondria myopathy, encephalopaty, lactic acidosis and stroke-like episodes), important factors for diagnosis are the increase of lactic acid value in blood and cerebro-spinal fluid, stroke-like symptoms, pathological evidence of ragged-red fibers in muscle fiber by Gomori-trichrome staining in muscle biopsy, and abnormal biochmical mitochondrial findings, and it is characterized by diverse clinical features. It is a genetic disease first reported by pavlalkis et al in 1984. We perfomed anesthesia in bilateral foot muscle release operation for a patient with MELAS who had paralytic pes equinovarus (paralytic club foot) showing clinical features different from those found in the past report. The results of our study are reported.

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Duodenal adenocarcinoma with diffusely infiltrative growth is a rare tumor. This report presents a patient with a diffusely infiltrative duodenal adenocarcinoma that did not include marked ulceration. The patient's chief complaint was vomiting. The cancer was diagnosed on the basis of an endoscopic biopsy of the tumor. The patient underwent pancreaticoduodenectomy. Pathologic examination showed a duodenal carcinoma with diffusely infiltrative growth. The cancer was diagnosed as an annular-type duodenal adenocarcinoma because of the absence of marked ulceration.

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