[Randomized controlled study of high-dose metoclopramide (2 mg/kg x 4:H) vs moderate-dose metoclopramide (1 mg/kg x 4:M) in the prevention of CDDP-induced emesis].

A comparison of the antiemetic effects of (H) and (M) was carried out by randomized control study in gynecologic cancer patients receiving CDDP (35-110 mg/m2). Metoclopramide was given at a dosage of 2 mg/kg (H) or 1 mg/kg (M), intravenously, 30 minutes before and 2.5 hours, 5.0 hours, and 7.5 hours following chemotherapy. Treatment with (H) resulted in 3.3 episodes of vomiting (range 0-5) whereas the episodes of vomiting noted with (M) were 3.4 (range 1-5). In patients receiving CDDP (H) or (M) dosage of metoclopramide gives similar antiemetic protection.

[Effectiveness of Ge-132 to relieve pain and smooth home care administration for the terminal cancer patient].

Measures to alleviate pain are the most important issue in care of the cancer patient. In the present study, we investigated whether the use of narcotics could be reduced in the use of Ge-132 (Repargermanium) when used alone or together with a narcotic as a means to facilitate pain management in home care. The patients have died at home over the past 2 years with various types of cancer under our hospital supervision. Five were cases of bone metastasis, 6 of ascites. All cases had been given Ge-132, 750 approximately 2,500 mg/day (mean 1,000 mg) either orally or by IV. For pain control the first choice was MS Contin, and when the need arose the route used was intravenous or by suppository. We investigated the rate of narcotic usage and the dosage of same. Narcotics were used in 7 of the 16 patients (44%) who died at home, and the daily dose was 20 approximately 240 mg (mean 60 mg). By using Ge-132 as a pain killer the rate of narcotics use and the dosage were decreased, resulting in less side effects from the narcotics. Thus, Ge-132 proved effective in relieving the pain of the terminal cancer patient receiving home care, and since it has no side effects it assures smooth home treatment.

[cis-Dichlorodiammine platinum (II) in the treatment of advanced colo-rectal cancer].

The effect of CDDP was evaluated in 10 cases of advanced colo-rectal cancer. Prior chemotherapy was done in seven cases and three were fresh cases. The dosage of CDDP was in the range of 70-100 mg/m2 per individual. Seven cases out of 10 receiving the CDDP chemotherapy achieved no change and there were three cases of PD. Response rate was 0%. Values of serum creatinine and BUN were transiently evaluated and bone marrow toxicity was moderate. Emesis of patients treated with CDDP was suppressed by the administration of high doses of metoclopramide (2 mg/kg X 4 times).

[Prevention of stomatitis induced by anti-cancer drugs].

A randomized control trial study was carried out to evaluate the effect of allopurinol mouth wash on stomatitis induced by chemotherapy in gynecologic patients. Chemotherapeutics used consisted of 5-FU+CDDP (PF) given to 10 patients and vincristine and actinomycin-D+cyclophosphamide (VAC) given to 5. Allopurinol mouth wash was prepared for patients to rinse their mouth with the solution 4-5 times daily before and after treatment with anti-cancer drugs. The Japan Society For Cancer Therapy's criteria for stomatitis were used. In the control group, stomatitis occurred in 9 of the 10 patients receiving PF therapy and in all of the 5 receiving VAC. In contrast, stomatitis was observed in only 2 of the 10 patients receiving PF therapy and 2 of the 5 VAC in the allopurinol-treated group. Allopurinol mouth wash showed a marked effect on stomatitis induced by chemotherapy.

[Home hospice care at a clinic].

For the people who want to stay at home until their last day, the primary doctor and clinic where they were diagnosed will be the most reliable supports. We have been operating a 19 bed clinic since 1996. In these three years, we have established what we call a "combination palliative care system." A team composed of two doctors, 13 nurses, 3 care aids, a social worker, and a counselor provides home care services as well as outpatient and inpatient care. From April, 1998 to March, 1999, 59 patients died of cancer. Among them, 25 patients died at home. Their primary cancers were lung (7), colon (3), pancreatic (2), breast (2), ovarian (2), brain (1), stomach (1), hepatoma (1), neck (1) and others. First of all, sufficient consultation with patients and family makes this care successful. Through this, the patient can choose his style of care. The whole staff is involved in this care in turn, so that all of us become acquainted with each patient. Home care includes: 1) medical and nursing service available 24 hours a day, 2) activation of social resources for the support of the patient user, 3) constructive cooperation with relevant institutions, 4) relieving the patient's physical and mental suffering, 5) aroma therapy, oil massage, hair cuts and music therapy, and 6) support by volunteers. In this way, as a neighborhood clinic, the combination palliative care system is valuable.

[Home palliative care of brain tumor patients from our clinic].

This study investigated whether or not home palliative care of brain tumor patients was possible and various ideas for accomplishing this, over the 2 1/2 years since our clinic was opened. There were 22 patients, aged 42-72 years, comprising 7 cases of glioblastoma, 14 cases of metastatic brain tumor, and 1 case of unknown origin. The control of intracranial hypertension and attacks of convulsion was possible with oral medication or suppositories, but not injection. The prognosis of cancer patients which changed home care showed no remarkable changes, and the home care rate was 53%. Malignant brain tumor patients were able to enjoy time with their families at home during the terminal stage, and die with dignity.

[Comparison of the effects of interferon of various types on the cytotoxic activity of NK cells].

Various types/sources of interferons were tested for their ability to modulate the (cytotoxic) activity of natural killer (NK) cells in different effector cells (human peripheral blood lymphocytes) and target cells (K 562 or PC 9) ratios and the concentration of IFN. NK activity was examined by two methods: IFN and lymphocytes were added in the assay system directly or were precultured before assay. NK activity increased with the dosage of IFN in both experiments and reached a peak level at six to 12 hours preculture with every IFN. The augmenting effect of each interferon on NK activity was different even if the same unit of interferon was used for experiment. For the determination of optimal BRM dose of interferon, the measurement of NK activity provides the essential tool.

The development of hypercalcemia in a patient with an ovarian tumor producing parathyroid hormone-related protein.

Hypercalcemia developed in a 34-year-old woman with a clear cell carcinoma of the ovary. Osseous involvement with the tumor cells was not present. Primary hyperparathyroidism was absent. Operative partial resection of the metastatic supraclavicular lymph node, followed by radiation therapy, decreased her serum calcium concentrations. This case belongs to the category of humoral hypercalcemia of malignancy (HHM). Detection of a significant quantity of immunoreactive parathyroid hormone-related protein (PTH-rP) in the metastatic lymph node suggested that the HHM of the patient was induced by PTH-rP produced by the tumor. From a review of 17 cases of ovarian tumors showing HHM-like morbidity, it was found that clear cell carcinoma and cystadenocarcinoma were the major types of ovarian tumors associated with HHM.

[The prognosis of ovarian cancer depends on the CA125 value at the end of induction therapy].

The prognosis of ovarian cancer depends on the CA125 value at the end of induction therapy. The relationship between the prognosis and the CA125 value at the end of induction therapy was analysed in 16 ovarian cancers. In the group with a CA125 value less than 35 units/ml after the induction therapy (initial surgery + 3 courses of chemotherapy) all patients have survived for 18-45 months since the initial treatment to the present, whereas in the group with a CA125 value above 35 units/ml all patients died within 16 months after the initial treatment. Comparison of the survival rates in these two groups showed a significant difference. These results suggest that the most important factor that affects prognosis in patients with ovarian cancer is the normalization of the CA125 value after the induction therapy.

[Experimental chemotherapy of germ cell tumor heterotransplanted to nude mice].

While the treatment of ovarian cancer has made remarkable progress in recent years, the chemotherapy of ovarian germ cell tumor has not as yet been fully established and remains to be improved. We investigated the effectiveness of a single-agent therapy with Vincristine (VCR), Actinomycin D (ACD), and Cyclophosphamide (CPM) against a human undifferentiated dysgerminoma's cell line (JOHYL-1) with the following results. The ratio of the number of viable cells to the total cell population treated for JOHYL-1 cells of ascitic type was 70% with VCR, 58% with CPM and 25% with ACD; hence the efficacy on this malignant cell line was the greatest with ACD followed by VCR and CPM in that descending order. Notably with CPM, a striking antitumor effect was observed from 48 to 24 hours after treatment. The L.I. attained a peak at 24, 18 and 30 hours, respectively, after treatment with VCR, ACD and CPM. The M.I. was as high as a little more than 6% at 36 hours after treatment with VCR. There also was noted a shift in the cell cycle with any of the test drugs. Morphological changes observed in the cell were most obvious with ACD followed in order by VCR and CPM. LDH & isozyme pattern: In these respects there were no striking differences among the three drugs, even though the total enzyme activity was somewhat higher with VCR.(ABSTRACT TRUNCATED AT 250 WORDS)

[Prognostic study of ovarian clear cell carcinoma].

Prognostic studies were performed on 17 cases with clear cell carcinoma of the ovary. The results are follows: 1) The average age was 45.9 years and ranging from 35 to 57 years. 2) Regarding the FIGO clinical stage, all of 5 patients with stage I and 3 of 5 with stage II survived over 2 years, while all of patients with stage III and 2 with stage IV were dead within 2 years. 3) Of 9 patients who had complete resection for primary operation, 8 (89%) survived over 2 years. All of 8 patients who had incomplete resection were dead within 2 years. 4) All cases had been received various chemotherapy; CQ + 5-FU (n = 5), CPM + ADM + CDDP + 5-FU (n = 7), 5-FU + CPM + MMC (n = 2), CDDP (n = 1), CDDP + MMC + 5-FU (n = 1), MCNU + VCR + 5-FU (n = 1), but none of them improved the prognosis of this histological type. 5) With or without administration of CDDP, there was no significant difference in the prognosis. These results suggest that early diagnosis of disease, curative surgical resection and selection of effective chemotherapeutic agents are important things to improve prognosis of clear cell carcinoma of the ovary.

[The prevention of CDDP-induced emesis with a combination regimen including metoclopramide, dexamethasone, droperidol and diphenhydramine].

The dose limiting factors of cisplatinum are nephrotoxicity and emesis. Nephrotoxicity has been reduced by hydration but nausea and vomiting caused by cisplatinum have led to refusal of potentially curative therapy by a number of patients. The prevention of nausea and vomiting by a combination of antiemetic drugs administered to ovarian patients receiving chemotherapy inducing (cisplatinum 50mg/m2, adriamycin 300 mg/m2, cyclophosphamide 300 mg/m2 and 5FU 350 mg/m2) was studied. the combination antiemetic drugs were metoclopramide (1mg/kg), dexamethasone (10mg/m2), droperidol (1mg/m2) and diphenhydramine (20mg/body). These drugs without diphenhydramine were administered intravenously 30 minutes before and 2.5 hours, 5 hours and 7.5 hours after chemotherapy. Diphenhydramine was administered intramuscularly 30 minutes before and 5 hours after chemotherapy. No vomiting was noted in 82.6% (19/23) of cases, and no patient vomited more than four times. This combination regimen provided very good protection against cisplatinum induced emesis.

[Interstitial irradiation with Ir-192 in carcinoma of the female genital tract--report of two cases].

Two patients treated with interstitial iridium-192 irradiation are presented. A patient with stage IV A adenocarcinoma of the uterine cervix was treated with external irradiation in combination with local hyperthermia prior to the interstitial irradiation. Another patient with stage III B squamous cell carcinoma of the vagina had a hysterectomy followed by irradiation 22 years prior to the treatment. Wires of Iridium-192 were put into place in the region of the tumor to give 40 Gy to the periphery of the tumor. The patient with carcinoma of the cervix died 15 months after the treatment. The patient with carcinoma of the vagina is well and has locally controlled disease 18 months after the treatment.