Low-level laser therapy alleviates mechanical and cold allodynia induced by oxaliplatin administration in rats.

PURPOSE: Cold and mechanical allodynia caused by oxaliplatin-induced acute peripheral neuropathy frequently occur after drug infusion. Low-level laser therapy (LLLT) has been used to improve pain symptoms associated with various conditions and may have potential as a therapy for oxaliplatin-induced allodynia. The purpose of the present study was to investigate the antiallodynic effect of LLLT in an oxaliplatin-treated animal model by assessing sensory behavioral responses, levels of nerve growth factor (NGF), and transient receptor potential M8 (TRPM8) in dorsal root ganglia (DRG) neurons, as well as substance P (SP) in the spinal dorsal horn. METHODS: Adult male Sprague-Dawley rats each received a total of four doses of oxaliplatin (4 mg/kg, i.p.), injected at 3-day intervals. Following oxaliplatin administration, LLLT (7.5 J/cm(2)) was applied for 12 consecutive days to the skin surface directly above sites where the sciatic nerve is distributed. Behavioral assessments were then performed, followed by immunoassays for NGF, TRPM8, and SP proteins. RESULTS: LLLT relieved both cold and mechanical allodynia induced by oxaliplatin in rats. Oxaliplatin-related increases in protein levels of NGF and TRPM8 in DRG and SP in the dorsal horn were also reduced after LLLT. CONCLUSION: The findings of this study support LLLT as a potential treatment for oxaliplatin-induced neuropathy. Moreover, our findings suggest that SP, TRPM8, and NGF proteins in the superficial dorsal horn and DRG may be involved in an antiallodynic effect for LLLT.

Prostaglandin-D synthetase induces transcription of the LH beta subunit in the primary culture of chicken anterior pituitary cells via the PPAR signaling pathway.

Downstream effects of prostaglandin-D synthetase (PGDS) in a primary culture of chicken (Gallus gallus) anterior pituitary cells were investigated to study how PGDS regulated laying in hens. Either PGDS downstream metabolite, PGD(2) or PGJ(2), elevated LHB mRNA and LHB protein levels in dose- and time-dependent manners, and treatment with arachidonic acid (1 microM) alone upregulated 15-deoxy-Delta(12,14)-PGJ(2) (15-d-PGJ(2); derived from PGJ(2))/PGJ(2), LHB mRNA, and LHB protein levels (P<0.05) in the primary culture of chicken pituitary anterior cells. Transfection of the plasmid Enhanced Green Fluorescent Protein-PGDS plasmid into these cells in medium containing 1 microM arachidonic acid additionally increased 15-d-PGJ(2)/PGJ(2), LHB mRNA, and LHB protein levels (P<0.05). In the hypothalamus/pituitary gland of laying hens, there was a high correlation (r=0.64; P<0.05) between PGDS and the peroxisome proliferator-activated receptor A (PPARA) mRNA level in a high egg production strain, the L2 Taiwan country chickens. In commercial Single-Comb White Leghorn layers, there were high correlation coefficients between PGDS and PPARA (r=0.65; P<0.05) and between PGDS and PPARG (r=0.67; P<0.01) mRNA levels. A broad-range PPARs agonist, GW9578 (5 to 500 nM), enhanced LHB mRNA and LHB protein levels (P<0.05). The PPARA-specific (GW6471) and PPARG-specific (T0070907) antagonists suppressed endogenous LHB mRNA and LHB protein levels (P<0.05); in addition, both antagonists attenuated arachidonic acid-induced LHB mRNA levels (P<0.05) and PGDS-induced (in the presence of 1 microM arachidonic acid) LHB mRNA and LHB protein (P<0.05) levels in the primary culture of chicken anterior pituitary cells. Higher LHB mRNA/LHB protein ratios in PGD(2)-, PGJ(2)-, arachidonic acid-, PGDS-, and GW9578-induced as well as GW6471- and T0070907-suppressed anterior pituitary cells suggested that LHB transcription occurred before translation. In conclusion, PGDS induced LHB transcription and subsequent translation via the PPAR signaling pathway.

Long-term results of Taiwan Pediatric Oncology Group studies 1997 and 2002 for childhood acute lymphoblastic leukemia.

The long-term outcome of 1390 children with acute lymphoblastic leukemia (ALL), treated in two successive clinical trials (Taiwan Pediatric Oncology Group (TPOG)-ALL-97 and TPOG-ALL-2002) between 1997 and 2007, is reported. The event-free survival improved significantly (P=0.0004) over this period, 69.3+/-1.9% in 1997-2001 to 77.4+/-1.7% in 2002-2007. A randomized trial in TPOG-97 testing L-asparaginase versus epidoxorubicin in combination with vincristine and prednisolone for remission induction in standard-risk (SR; low-risk) patients yielded similar outcomes. Another randomized trial, in TPOG-2002, showed that for SR patients, two reinduction courses did not improve long-term outcome over one course. Decreasing use of prophylactic cranial irradiation in the period 1997-2008 was not associated with increased rates of CNS relapse, prompting complete omission of prophylactic cranial irradiation from TPOG protocols, beginning in 2009. Decreased use of etoposide and cranial irradiation likely contributed to the low incidence of second cancers. High-risk B-lineage ALL, T-cell, CD10 negativity, t(9;22), infant, and higher leukocyte count were consistently adverse factors, whereas hyperdiploidy >50 was a consistently favorable factor. Higher leukocyte count and t(9;22) retained prognostic significance in both TPOG-97 and TPOG-2002 by multivariate analysis. Although long-term outcome in TPOG clinical trials is comparable with results being reported worldwide, the persistent strength of certain prognostic variables and the lower frequencies of favorable outcome predictors, such as ETV6-RUNX1 and hyperdiploidy >50, in Taiwanese children warrant renewed effort to cure a higher proportion of patients while preserving their quality of life.

Improved treatment results for childhood acute myeloid leukemia in Taiwan.

To improve treatment results for children with de novo acute myeloid leukemia (AML), we introduced a novel protocol, Taiwan Pediatric Oncology Group-AML-97A, for AML other than acute promyelocytic leukemia (APL), for which modified conventional protocols were used. From January 1, 1997, to December 31, 2002, 141 children younger than 17 years old with de novo AML were enrolled. In total, 117 patients with non-APL AML were treated with induction therapy of idarubicin and cytarabine (Ara-C), postremission therapy with high-dose Ara-C - containing regimens for four monthly courses, and moderate-dose therapy with idarubicin and Ara-C for four monthly courses. The first 19 patients with APL were treated with all-trans retinoic acid, idarubicin and Ara-C, with the remaining five patients receiving all-trans retinoic acid and idarubicin, followed by maintenance therapy for 2 years. Stem cell transplantation was performed in 29 patients in first remission with a similar outcome as chemotherapy alone. The remission rate in the AML-97A study was 90%, the 5-year survival 51 +/- 5.3% (s.e.) and the 5-year event-free survival 50 +/- 4.8%; for APL, these were 100%, 86 +/- 7.0, and 75 +/- 9.8%. For the whole group, the 5-year survival was 57 +/- 4.7% and the 5-year event-free survival 54 +/- 4.4%. The AML-97A regimen was well tolerated.

Pleural effusion and serum soluble fas-ligand levels are elevated in different clinical conditions.

Fas ligand (FasL) plays an important role in the regulation of apoptosis. Soluble FasL (sFasL) is produced by a cleavage of FasL from the cell surface by metalloproteinase. Whether or not sFasL exists or is elevated in the pleural effusion of different etiologies is unknown. The present study is designed to determine pleural effusion and serum sFasL levels under different clinical conditions, and ascertain if there exists a significant difference in the levels found in different clinical conditions, and whether this difference can be used as a tool for differential diagnosis. Soluble FasL levels in the pleural effusion and serum of 103 patients, including 37 with malignant pleural effusion, 24 with uncomplicated parapneumonic effusion, 8 with bacterial empyema, 16 with tuberculous pleurisy, and 18 with transudate effusion (8 with congestive heart failure and 10 with viral liver cirrhosis), were analyzed with ELISA assays. Pleural effusion from patients with bacterial empyema (median 79.4 pg/ml) and TB pleurisy (median 31.9 pg/ml) contained significantly higher amounts of sFasL than the pleural effusion from all other conditions studied (p <0.001). Viral liver cirrhosis had a significantly higher serum sFasL level (median 53.6 pg/ml, p = 0.025, when compared with other patients). Patients with congestive heart failure had the lowest serum sFasL levels when compared with other patients (p = 0.014). There was no significant correlation between pleural effusion sFasL levels and other parameters, such as effusion LDH, cell count, neutrophil, and lymphocyte percentage. In conclusion, soluble FasL is a useful marker for the differentiation of bacterial empyema and TB pleurisy from other disease entities. In addition, the elevation of serum sFasL levels in viral liver cirrhosis can also be used to differentiate cirrhosis from congestive heart failure, in which both effusions are transudate.

Nonmyeloablative allogeneic bone marrow transplantation for orbital granulocytic sarcoma associated with t(8;21)(q22;q22) in acute myeloid leukemia.

We report a nonmyeloablative allogeneic bone marrow transplant (allo-BMT) from an HLA-matched unrelated donor in a case of acute myeloid leukemia (AML), M2 with t(8;21)(q22;q22) and the presence of orbital granulocytic sarcoma (GS), who had residual tumor after conventional chemotherapy. The course of BMT was well tolerated, with no major procedure-related toxicity. The residual orbital GS regressed completely 4 months after BMT. She is currently 19 months post BMT, disease-free. To our knowledge, this is the first reported pediatric patient with AML, GS and t(8;21)(q22;q22) who received a nonmyeloablative allo-BMT.

Prenatal exposure of testosterone prevents SDN-POA neurons of postnatal male rats from apoptosis through NMDA receptor.

The role of N-methyl-D-aspartate (NMDA) receptor in mediating the effect of testosterone exposure prenatally on neuronal apoptosis in the sexual dimorphic nucleus of the preoptic area (SDN-POA) of rats was studied. The endogenous testosterone was diminished by prenatal stress (PNS) or simulated by testosterone exposure (TE) to understand the effect of testosterone on NR(1) (a functional subunit protein of NMDA receptor) expression and neuronal apoptosis. To further study whether the testosterone, after being converted into estradiol, modulates NR(1) expression, 4-androstein-4-ol-3,17-dione (ATD; an aromatase inhibitor) was used to block the conversion of estradiol from testosterone. The expressions of the NR(1) mRNA and NR(1) subunit protein were quantified by RT-PCR and western blotting analysis, respectively. In addition, a noncompetitive antagonist of NMDA receptor, MK-801, was used to find out whether blockage of NMDA receptor affects the naturally occurring apoptosis in SDN-POA. The results showed the following. 1) Expression of perinatal NR(1) subunit protein in the central part of the medial preoptic area of male rats was significantly higher than that of females, especially on postnatal days 1 and 3. 2) The testosterone level of male fetuses on embryonic day 18 was significantly higher than that of females, while the testosterone level of TE females or PNS males was similar to that of intact males or intact females, respectively. 3) The apoptotic incidence of intact male rats was significantly less than that of females, and the apoptosis was stimulated by PNS in male or inhibited by TE in female. 4) The expression of NR(1) subunit protein could be inhibited by PNS or ATD-treatment in male, while stimulated by TE in female. 5) NR(1) mRNA showed no significant difference among intact male, PNS male, ATD-treated male, TE female and intact female rats. 6) The low apoptotic incidence of male rats was significantly increased when NMDA receptor was blocked by MK-801. These results suggest that testosterone, after being converted to estradiol, may prevent the SDN-POA neurons of male rats from apoptosis through enhancing the expression of NR(1) at the posttranscriptional level.

Molecular cloning of the cDNAs for pituitary glycoprotein hormone alpha subunits of two species of duck and their gene regulation.

The cDNAs encoding pituitary glycoprotein hormone alpha subunits (PGHalphas) of two species of duck (Muscovy duck, Cairina moschata and Pekin duck, Anas platyrhynchos domesticus) were cloned and sequenced to better understand the phylogenic diversity and evolution of PGHalpha molecules in vertebrates. Oligonucleotide primers were designed and used for reverse transcription PCR (RT-PCR) amplification of PGHalpha cDNA fragments from total cellular RNA of pituitary glands. The remaining sequences were completed by rapid amplification of the cDNA ends. The nucleotide sequence of isolated PGHalpha cDNA of both ducks are identical, including 81 bp of 5' untranslated region (UTR), 360 bp of coding region, and 272 bp of 3'-UTR followed by a 13 bp poly(A)(+) tract. The total number of amino acids deduced from the cDNA of the duck PGHalpha is 120 with a signal peptide of 24 amino acids and a mature protein of 96 amino acids. PGHalphas of the ducks (order Anseriformes) share 96% homology of amino acid sequence in signal peptide, and 100% homology in mature proteins with chicken, quail and turkey (order Galliformes). Our data thus demonstrate identical inter-order homology of PGHalpha mature protein in birds. Ten cysteine residues, presumably forming five disulfide bonds within the alpha subunit, and four proline residues, presumably responsible for folding of the molecule, are conserved in the alpha subunit of ducks. Northern blot analysis revealed that PGHalpha mRNA is expressed only in the pituitary. In order to study factors regulating the gene expression of PGHalpha mRNA, duck pituitary fragments were incubated with GnRH, TRH, testosterone, or triiodothyronine (T(3)). GnRH and TRH increased, while testosterone and T(3) decreased, PGHalpha mRNA levels. This is the first report in birds of TRH up-regulation and down-regulation by testosterone and T(3) under in vitro conditions. The present study demonstrates both ducks have the same cDNA nucleotide and deduced amino acid sequences in the PGHalpha subunit, exhibiting identical inter-genus homology within the family of Anatidae. The findings from mRNA expression work suggest that hypothalamic GnRH and TRH up-regulate, while testosterone and T(3) down-regulate, PGHalpha gene expression in ducks.

Presence of Epstein-Barr virus latent membrane protein 1 gene in the nasopharyngeal swabs from patients with nasopharyngeal carcinoma.

BACKGROUND: Nasopharyngeal carcinoma (NPC) is the most common head and neck malignancy in southeastern China and Taiwan. Early detection of the local disease followed immediately by proper treatment is essential to increase the cure and survival rates. Because every NPC tumor cell carries Epstein-Barr Virus (EBV) genomes, detection of EBV genomic DNA such as latent membrane protein 1 gene (LMP1) might indicate the presence of NPC. We developed a simple and noninvasive technique of nasopharyngeal swabbing to acquire nasopharyngeal cells for detecting the presence of EBV genome. The aim of this study was to investigate the feasibility and reliability of this technique. METHODS: We collected nasopharyngeal cells by means of a nasopharyngeal swabbing technique and detected the presence of EBV LMP1 with polymerase chain reaction (PCR). Thirty-eight swab specimens were obtained from patients with NPC who were newly diagnosed or were just beginning radiotherapy. Two groups of control subjects were recruited, including 20 patients with other head and neck cancers and eight family members of the NPC patients. An additional group of 65 NPC patients were enrolled in the course of regular follow-up after definitive radiotherapy. RESULTS: All of the samples yielded sufficient DNA for PCR amplification. Thirty-six of 38 NPC swab samples were positive for EBV LMP1, and all the control subjects had swab sample results negative for EBV. All five patients with suspected local recurrence exhibited positive EBV test results. CONCLUSIONS: Demonstration of EBV LMP1 in the nasopharyngeal swab specimens detected NPC with a sensitivity of 94.7% and specificity of 100%. This study confirms the reliability and feasibility of nasopharyngeal swab in the predicting and screening of NPC.

Intestinal metastasis causing intussusception in a patient treated for osteosarcoma with history of multiple metastases: a case report.

Intestinal intussusception caused by metastatic tumors is a very rare condition. Preoperative diagnosis is not easy because of the condition's rarity and because of mild abdominal physical presentation. We report on a patient with osteosarcoma who suffered from abdominal pain and emesis during the period of autologous peripheral blood stem cell transplantation. He had undergone tumor excision and radiotherapy several times prior to autologous peripheral blood stem cell transplantation because of multiple metastases. Intestinal metastasis was suspected initially by computed tomographic scan and sonogram and was proved by surgical resection and pathological findings. Clinicians caring for pediatric patients with osteosarcoma with a history of multiple metastases should consider the possibility of intestinal metastases when equivocal abdominal symptoms develop after intensive chemotherapy.

Effects of indoor environmental factors on risk for atopic eczema in a subtropical area.

The objective of this study was to examine the relationship between indoor environmental factors and atopic eczema in a subtropical area. A case-control study was performed using participants from a survey that included 144 school children with atopic eczema and 144 age- and gender-matched controls. The study was confined to 4,164 primary school children aged 6-12 yr attending 8 primary schools in Kaohsiung rural municipalities who participated in the study. Cases of atopic eczema were ascertained by asking whether a physician had ever diagnosed this condition in the child. Information regarding the home environment was obtained using a structured written questionnaire, completed by the parents of the children. Of the many indoor environmental factors included in this study, such as dampness and smoking, none was found to be associated with atopic eczema.

Lactitol-based poly(ether polyol) hydrogels for controlled release chemical and drug delivery systems.

The hydroxyl groups of lactitol were propoxylated to produce poly(ether polyol) (LPEP). The average pK(a) value of hydroxyl groups of the polyol was 1.63. Cross-linked hydrogels were synthesized by esterification with chlorinated poly(ethylene glycol) bis(carboxymethyl) ether (PEGBCOCl). The swelling ratio decreased with increasing cross-linking ratio (PEGBCOCl:LPEP) from 2:1 to 4:1 in the hydrogels and was sensitive to temperature change between 25 and 55 degrees C and concentrations of salt and glucose. The swelling ratio did not change significantly with pH in the range of 4-9. The release profiles of a model active agent, acetylsalicylic acid, from the hydrogels showed that the diffusional release rate had a half-order dependence on time, and the diffusivity decreased with increasing cross-linking ratio. This work demonstrated that LPEP-based hydrogels can be used for controlled delivery of drugs and agrochemicals and the release rates can be controlled with the cross-linking ratio of the hydrogel.

Treatment results of the TPOG-NHL92 protocols for childhood non-Hodgkin's lymphomas in Taiwan: a report from the Taiwan Pediatric Oncology Group (TPOG)

A nation-wide chemotherapeutic trial for childhood non-Hodgkin's lymphoma (NHL) was conducted by the Taiwan Pediatric Oncology Group (TPOG). Four TPOG-NHL92 protocols based on stage and histology were activated in 1992: TPOG-92LD (treatment duration: 8 months) was used for localized (stages I/II) NHL with any histology, 92LB (2 years), 92SNC (5 months), and 92LC (1 year) for advanced (stages III/IV) lymphoblastic (LB), small non-cleaved cell (SNC), and large cell (LC) lymphoma, respectively. From January 1992 through June 1998, 200 children with newly diagnosed NHL from 13 member hospitals of TPOG were enrolled. There were 140 boys and 60 girls. Their ages at diagnosis ranged from 2.4 months to 18.3 years with a median of 8.2 years. There were 54 (27.3%) patients with LB, 94 (47.5%) with SNC including B-cell acute lymphoblastic leukemia (B-ALL), and 50 (25.2%) with LC. Stages I, II, III, and IV (including B-ALL) of the disease comprised 5%, 10%, 43%, and 42% of cases, respectively. There were 176 patients eligible for evaluation of treatment results. The remission rate of induction was 82.4%, induction failed in 22 (12.5%) patients, and nine patients died during induction. As of August 31, 1999, 26 patients relapsed, six died during remission, one patient developed secondary acute myelomonocytic leukemia, and 105 patients remained in continuous remission with a median remission duration of 49 months. The event-free survival (EFS) at 7 years was 63.5%, 61.5% and 65% for LB, SNC, and LC groups (P = 0.8298). The 7-year EFS for stages I/II, III, and IV of the disease was 73%, 68.9%, and 50.3% (P = 0.0212), respectively. We concluded that following the strategy of stratification of therapy, only disease stages had prognostic significance in this study. More efforts are needed to improve our treatment results.

Evaluating the protective role of the olivocochlear bundle against acoustic overexposure in rats by using Fos immunohistochemistry.

Efferent inhibition on the cochlea is suggested as a possible function of the olivocochlear bundle (OCB). Substantial evidence supports the finding that the OCB may protect the inner ear from noise-induced damage. However, there is relatively less known about the effects of noise on the central auditory transmission compared to the effects on the periphery. In the present animal study, two experimental paradigms were designed to analyze the influence of OCB lesion on the central auditory transmission following acoustic overexposure. In order to evaluate the animal's auditory function, its hearing threshold and the tone-evoked Fos expression shown in auditory nuclei were examined. Fos is a protein product of proto-oncogene c-fos. Via appropriate acoustic stimulation, Fos expression reveals the activated neuronal elements along the ascending auditory pathway. Thus, in experiment 1, no exposure sound was introduced and therefore no significant differences were shown in hearing thresholds and Fos expression among all rats, regardless of the status of their OCB. This result indicates that, without acoustic overexposure, OCB lesion caused no significant effect on brainstem auditory transmission. In contrast, in experiment 2, rats were exposed to continuous 8 kHz tones at 85 dB sound pressure level (SPL). A significantly increasing threshold was observed in rats with OCB lesion following an exposure period of 5 or 10 days. In addition, Fos expression was invisible first in rats with OCB lesion following 5-day exposure and almost no Fos expression could be examined in all rats after 10-day exposure. Taken together, the present data demonstrate that damaging the OCB renders an animal more easily vulnerable to acoustic damage than that of rat with intact OCB, and then reduces its cochlear activities, which eventually leads to increasing difficulty to induce tone-evoked Fos expression along the ascending auditory pathway.

Blockage of N-methyl-D-aspartate receptors decreases testosterone levels and enhances postnatal neuronal apoptosis in the preoptic area of male rats.

Sexual dimorphism has been found in the preoptic area of the hypothalamus (POA), a major site of glutamate actions via N-methyl-D-aspartate (NMDA) receptors. The sexually dimorphic nucleus of the preoptic area (SDN-POA) of male rats exhibits about seven-fold greater nuclear volume than that of females. A naturally occurring neonatal neuronal apoptosis, that can be prevented by testosterone, may contribute to this sexual difference in SDN-POA nuclear volume. Since activation of NMDA receptors in the POA induces GnRH secretion, it may be involved in both elevation of serum testosterone and prevention of neuronal death in the SDN-POA. In the present study, protein expression of NMDA receptors in the POA of male and female fetuses was quantified on the day preceding the fetal testosterone peak (embryonic day 16; ED 16). Rats were then distributed in four groups: (1) untreated males, (2) untreated females, (3) males pretreated with MK-801 (a noncompetitive NMDA receptor antagonist), and (4) females pretreated with MK-801. Serum levels of testosterone were estimated on the afternoon of ED 18. Expression of Bcl-2 and Bax, as well as neuronal apoptosis in SDN-POA, were observed on postnatal day 8. The results showed that (1) expression of NMDA receptors in the POA of male fetuses was higher than that of females on ED 16; (2) levels of testosterone were lower in MK-801 pretreated male fetuses than in intact males on ED 18; (3) expression of Bcl-2 in the POA of MK-801 pretreated male rats was significantly less than that of control males; (4) the apoptotic incidence in the SDN-POA of MK-801 pretreated male rats was significantly greater than in control males, while there was no significant difference in apoptotic incidence in the SDN-POA between MK-801 pretreated and intact females. These results suggest that the NMDA receptor is highly expressed in prenatal male fetuses, and that it might play an important role in the elevation of testosterone levels. Moreover, activation of NMDA receptors may protect SDN-POA neurons from naturally occurring neuronal death, by modulating testosterone and/or Bcl-2 expression.

Observations after orchiectomy in clinical stage I nonseminomatous germ cell tumors of the testis.

BACKGROUND: The optimal management of clinical stage I nonseminomatous germ cell tumor (NSGCT) of the testis remains controversial. For years, retroperitoneal lymph node dissection in combination with orchiectomy, has been the standard treatment in patients with clinical stage I NSGCT. Recently, with advancement of effective cisplatin-based chemotherapy and clinical staging procedures, a new approach of observation after orchiectomy is being evaluated. We reviewed cases of orchiectomy and observation for clinical stage I NSGCT of the testis in order to evaluate the treatment outcome. METHODS: We retrospectively reviewed the records of 13 patients with clinical stage I NSGCT of the testis treated at our hospital from February, 1981 to August, 1996. The patient age at diagnosis ranged from 0.6 to 44 years. Nine patients had yolk sac tumors, and four had mixed germ cell tumors. Median follow-up was 42 months (range, 20-132 months). RESULTS: Prior to orchiectomy, serum beta-human chorionic gonadotropin and alpha-fetoprotein (AFP) were raised to abnormal concentrations in four and in 13 patients, respectively. With a median follow-up of 42 months, three of 13 patients relapsed at a median of three months after orchiectomy. Two patients showed elevated AFP and radiographically identifiable tumors simultaneously, and one patient showed elevated AFP as the only evidence of relapse. Following treatment with cisplatin-based chemotherapy, the three patients who relapsed responded successfully and the elevated AFP returned to normal. The patients are currently alive and disease free. CONCLUSIONS: Observation after orchiectomy is a reasonable approach for patients with clinical stage I NSGCT of the testis.

Postchemotherapy retroperitoneal residual mass in infantile yolk sac tumor.

BACKGROUND: Persistent postchemotherapy retroperitoneal residual mass with normalization of alpha-fetoprotein (AFP) in infantile yolk sac tumor is rare. METHODS/RESULTS: A 38-month-old boy with recurrent yolk sac tumor was treated with cisplatin-based combination chemotherapy. After chemotherapy, the retroperitoneal lymph node metastasis, 7 x 6 cm in size, decreased to 2 x 2 cm. Serum AFP levels returned to normal. The retroperitoneal residual mass was resected and histologically showed complete necrosis without viable cancer cells. CONCLUSION: The patient has remained free of disease for 36 months after operation.

Testicular yolk sac tumors in children.

BACKGROUND: Testicular tumors in children are uncommon, comprising about 1% of pediatric malignancies. Yolk sac tumor is the most common malignant testicular tumor in children. Because yolk sac tumor in children is rarely seen, its treatment has been controversial. We reviewed the records of 15 children with testicular yolk sac tumor treated at our hospital in order to evaluate optimal management and treatment outcome. METHODS: From February, 1981, to August, 1996, 15 children with testicular yolk sac tumor were treated. Mean patient age at diagnosis was 15.8 months (range, 7-22 months). Fourteen patients presented with stage I disease and one presented with stage III disease. Mean follow-up was 88 months (range, 2-156 months). RESULTS: All 15 patients received radical inguinal orchiectomy as initial treatment. Serum alpha-fetoprotein (AFP) concentrations were measured in 14 stage I patients preoperatively and were elevated in all of them. During follow-up, the one stage III patient died of the disease. Of the remaining 14 patients, two (14.3%) had recurrence with elevated AFP at three months and 10 months postorchiectomy, respectively. These patients were managed with cisplatin-based combination chemotherapy. To date, they are both alive with no further recurrence, and AFP concentrations returned to normal after chemotherapy. Overall, of the 15 patients with testicular yolk sac tumor, 14 (93.3%) survived without disease. CONCLUSIONS: Our results suggest that testicular yolk sac tumor in children is a tumor with a favorable prognosis. Serum AFP concentration is extremely useful in diagnosis and monitoring of treatment response. Radical inguinal orchiectomy alone seems adequate for patients with stage I disease if serum AFP concentrations return to normal postoperatively. Cisplatin-based combination chemotherapy should be administered in patients with tumor recurrence or metastasis.

Germ cell tumor in infancy and childhood: experience at one institute compared to other studies.

To understand the difference in incidence and distribution of germ cell tumor (GCT) between cases seen in this institute and Western studies, 98 cases of GCTs collected from 1979 to 1996 were included 50 with gonadal GCTs, 9 with mediastinal GCTs; 9 with retroperitoneal GCTs, 10 with sacrococcygeal GCTs and 20 with intracranial GCTs; all were analyzed retrospectively by chart review. The incidences of testicular and intracranial GCT in all GCTs were higher in this study, i.e. 26.5%(26/98) and 20.4%(20/98) compared to 7% and 6% of American reports. But the incidence of sacrococcygeal GCT in all GCTs was lower in this study, i.e. 10.2%(10/98) compared to 41% of American reports. The incidences of testicular and ovarian GCT in all GCTs were about the same in this study, i.e. 26.5%(26/98) and 24.5%(24/98) compared to 7% and 29% of American reports; 51%(50/98) of all GCTs were gonadal in this study compared to 36% in the American reports.

The relationship between population density and cancer mortality in Taiwan.

Many investigators have examined urbanization gradients in cancer rates. The purpose of this report was to identify urban-rural trends in cancer mortality rates (1982-1991) for municipalities in Taiwan. For this purpose, Taiwan's municipalities were classified as rural, suburban, urban, or metropolitan, using population density as an ordinal indicator of the degree of urbanization. Average annual age-adjusted, site-specific cancer mortality rates were calculated for both sexes within each population density group. Significant increasing trends with more urbanization were observed in mortality rates for cancers of the lung, pancreas, and kidney among both males and females, as well as male prostate cancer, and female breast and ovary cancer. In addition, this study revealed a significant rural excess for nonmelanoma skin cancer among both males and females, as well as male non-Hodgkin's lymphoma, and cancers of the female bone, and female connective tissue. Analytic studies for sites with consistent urban-rural trends may be fruitful in identifying the aspect of population density, or other unmeasured factors, that contribute to these trends.

PIP: Almost all studies which have reported variation in cancer incidence and mortality rates across urbanization gradients have found higher rates in urban populations than in rural areas. Findings are presented from a study conducted to identify urban-rural trends in cancer mortality rates during 1982-91 for municipalities in Taiwan. The countries municipalities were classified as rural, suburban, urban, or metropolitan, using population density as an ordinal indicator of the degree of urbanization. Average annual age-adjusted, site-specific cancer mortality rates were calculated for both sexes within each population density group. Significant increasing trends with more urbanization were observed in mortality rates for cancers of the lung, pancreas, and kidney among both men and women, as well as male prostate cancer and female breast and ovary cancer. The study also found a significant rural excess for non-melanoma skin cancer among men and women, as well as male non-Hodgkin's lymphoma and cancers of the female bone and connective tissue.