Correlation of EEG, neuroimaging and histopathology in an epilepsy patient with diffuse cortical dysplasia.

The correlation between scalp EEG, intraoperative electrocorticogram, neuroimaging and histopathology was examined in an epileptic child with diffuse cortical dysplasia. The 6-year-old girl with moderate mental retardation had suffered from intractable complex partial and generalized epilepsies since the age of 2 years. MR images demonstrated unilateral large macrogyria/polymicrogyria and schizencephaly in the right occipital lobe. The epileptic focus was detected on the macrogyria by EEG and single photon emission tomography. However, the intraoperative electrocorticogram showed frequent spikes from the polymicrogyria and no paroxysmal activity in the macrogyria. The polymicrogyria and the macrogyric lesion were resected, using an image-guided system. The histological findings revealed that the macrogyria was covered with and separated by glial bundles. It has been reported that epileptogenicity is produced from abnormal neurons and their arrangement in cortical dysplasia; in this case, however, the major dysplastic lesion had no epileptogenicity; rather the focus might be in the polymicrogyria around the lesion.

Secondary aortoduodenal fistula complicating aortic grafting, as a cause of intermittent chronic intestinal bleeding.

Intermittent intestinal bleeding persisted in a 77-year-old male, who had undergone grafting for abdominal aortic aneurysm. Each attack lasted for a few weeks and spontaneously resolved. Only a minute abnormality was found in the third portion of the duodenum; barium studies showed a segmental narrowing, but endoscopy disclosed only a small erosion in that portion. Massive and fatal gastrointestinal hemorrhage broke out 6 months after the onset of bleeding. Autopsy revealed an adhesion area with a small fistula formation between the duodenum and aorta. Even slight endoscopic findings should be considered suggestive of aortoenteric fistula in patients after aortic surgery.

[E-selectin expression in serum and tissue correlates with distant metastasis of colorectal cancer].

E-selectin is an adhesion molecule of endothelial cells that binds to cancer cells mediated by sialyl Lewis A (sLea) or sialyl Lewis X (sLex). It is suspected to be involved in hematogenous metastasis of tumors. Therefore, it is worth examining E-selectin expression in human colorectal cancer and its hepatic metastasis. In the present study, E-selectin was clearly revealed on the endothelial cells of small vessels adjacent to cancer nests in both primary and metastatic nests in immunohistochemistry. In these tissues, E-selectin was observed on the endothelial cells lining the lumen of small vessels. Its expression adjacent to cancer nests appears to be induced through some stimuli by cancer cells, since its degree of expression is inversely correlated to the distance of the blood vessels from the cancer nests (P < 0.001). Endothelial cells adjacent to the metastatic lesion expressed E-selectin more extensively than those adjacent to the primary foci. This is also in line with the finding on serum E-selectin levels which were significantly elevated in the metastatic group compared to the non-metastatic group. The serum E-selectin level may provide useful information in the diagnosis for hepatic metastasis of colorectal cancer, although the results are still very preliminary.

Expression of E-selectin on endothelial cells of small veins in human colorectal cancer.

E-selectin is an adhesion molecule of endothelial cells that binds to cancer cells mediated by sialyl Lewis A (sLea) or sialyl Lewis X (sLe(x)). It is suspected to be involved in hematogenous metastasis of tumors. Therefore, it is worth examining E-selectin expression in human colorectal cancer and its hepatic metastasis. In the present study, E-selectin was clearly revealed on the endothelial cells of small vessels adjacent to cancer nests both in primary and in metastatic nests in immunohistochemistry. In these tissues, E-selectin was observed on the endothelial cells lining the lumen of small vessels. Its expression adjacent to cancer nests appears to be induced through some stimuli by cancer cells, since its degree of expression is inversely correlated to the distance of the blood vessels from the cancer nests (p < 0.001). Endothelial cells adjacent to the metastatic lesion expressed E-selectin more extensively than those adjacent to the primary foci. This is also in line with the finding on serum E-selectin levels which were significantly elevated in the metastatic group as compared with the non-metastatic group. The serum E-selectin level may provide useful information in the diagnosis for hepatic metastasis of colorectal cancer, although the results are still tentative.

[Expression and prognostic indicators of type 1 and type 2 Lewis blood group antigens in colorectal cancers].

The immunohistochemical analysis using the monoclonal antibodies to the blood group antigens was performed on the tissues of 387 colorectal cancers and 307 normal colonic tissues, and the relation between expression of these antigens and prognosis of the patients with stage 2 was also investigated. La, Le(b), and CA 19-9 were used for type 1 antigens, and Le(x), Le(y), and Sialyl Le(x) for type 2, respectively. Expression of Ca 19-9 and Silyl Le(x) remarkably increased in cancers throughout the colorectum. Le(b) and Le(y) were expressed in only 0-17% of the normal distal colon, but in almost colonic tumors. Therefore CA 19-9 and Sialyl Le(x) are tumor-associated antigens in the whole colorectum, and Leb and Le(y) in the distal colon. Expression of CA 19-9 in primary tumor provided more prognostic information and risk of liver metastasis than other Lewis blood group antigens.

[The clinical effect of chemotherapy with 5-FU and low-dose CDDP in patients with advanced gastric cancer].

A trial of FP therapy, a novel systemic chemotherapy consisting of 5-FU and low-dose CDDP, was carried out in patients with advanced gastric cancer and the clinical effects were evaluated. Five hundred mg/body/day of 5-FU was continuously administered via the central venous catheter for 7 consecutive days and 10mg/day of CDDP was rapidly administered with 500ml saline on days 1-5. The regimen was repeated for at least 4 weeks. The FP therapy was carried out in 22 cases, including several patients who underwent FP as an adjuvant therapy; 1 CR, 2PR's 1MR and 2NC's were obtained among the 6 patients with clinically evaluable lesions, resulting in a response rate of 50%. In four cases, the FP therapy was given as a neoadjuvant therapy, and histopathological examination of the resected specimen revealed histological effects exceeding Grade 2 in all 4 cases. Bone marrow suppression was the most commonly observed side effect, but renal dysfunction and nausea were not found. FP therapy is considered an effective therapy against advanced gastric cancer, from the viewpoint of both the clinical and adverse effects, in comparison with conventional regimen consisting of 5-FU and a single and large dose of CDDP.

Experimental study on chemotherapy using adsorbent charcoal with CDDP administered directly into the mediastinum following esophagectomy.

In this study, 1500AA, an activated charcoal with a strong affinity for the lymphatic system, was examined for its ability to deliver chemotherapy to metastatic lymph nodes. First, the anticancer effect on metastatic lymph nodes was assessed in an experiment using the mouse mammary tumor, MM48. Pathological examination of the inguinal lymph nodes revealed a metastatic rate of 50% in the group given cisplatin (CDDP)-saline, but 20% in the group given CDDP-charcoal. Next, in a canine model, CDDP dissolved in normal saline was administered directly into the mediastinum, and CDDP was given with fine particles of activated charcoal in the same manner in the other group. The concentration of CDDP in the lymph nodes and the plasma rapidly increased to peak in 10 min in the CDDP-saline group, whereas it increased slowly to peak in 20-30 min in the CDDP-charcoal group. Moreover, the CDDP-charcoal group was found to have a much higher concentration of CDDP in the lymph nodes than the CDDP-saline group.

Pelvic actinomycosis presenting with a rectal stricture: report of a case.

We present herein the case of a patient with actinomycosis involving the pelvic cavity, who presented with a rectal stricture. It is rare for this type of actinomycosis to be accurately diagnosed preoperatively, but a precise diagnosis, made using needle biopsy guided by computed tomography allowed for successful treatment by resection of the granulation tissue surrounding the rectal stricture through a transsacral approach.

Expression of neural cell adhesion molecule in normal gastric mucosa and in gastric carcinoid tumors.

Expression of neural cell adhesion molecule (NCAM) in the digestive system was studied with NE-150 monoclonal antibody, together with those against Lewis blood group antigens. NE-150 did not react with any of 32 cell lines tested derived from digestive tract cancers. In gastric adenocarcinomas NCAM was not expressed regardless of its differentiation status, while in gastric carcinoids and in other carcinoid tumors of different organs, it was present in all the specimens tested. Among normal tissues, it reacted with the deep gastric gland and the islets of Langerhans. These results suggest that NCAM is one of the most specific markers for gastric carcinoid tumors. It was also suggested that the gastric carcinoid tumor might be derived from NCAM-positive cells in the deep gastric gland. These findings should be exploitable in subgrouping gastric tumors in terms of antigen expression.

[Expression and clinical significance of type-1 blood group antigens (Lea, Leb, CA19-9) in colorectal cancer--comparison with CEA].

The immunohistochemical analysis using the monoclonal antibodies to the blood group associated antigens Lea, Leb, CA19-9, and CEA, were performed on the tissues of the colorectal cancers, adenomas, normal mucosae and distant metastatic lesions, to determine whether the given degree of expression have some relation to the prognosis of patients or the potential of metastasis. We also analysed the serum levels of CA19-9 and CEA by RIA and compared them with the results of immunopathology. The more pronounced expression of CEA, Lea, Leb, and CA19-9 was observed in proportion to the progress of the cancer. In those cases of immunohistochemically Lea negative results in tissues, CA19-9 was not detected either in the serum level nor in tissue sections, therefore all cases of Lea negative results were eliminated in the evaluation of the clinical significance of CA19-9. Positive expression of CA19-9 in tissue of cancer indicated a poor prognosis of the patient and high risk of distant metastasis. Higher intensity of staining was observed in hepatic metastasis, in comparison with the primary lesion. These studies demonstrated that immunohistochemical analysis of CA19-9 and blood group antigens in useful tool for evaluation of prognosis and risk of metastasis in colorectal cancer.

A newly developed drug delivery system using fine particles of activated charcoal for targeting chemotherapy.

Targeting chemotherapy to the metastatic lesions of the lymph nodes after surgical removal of the main tumor, a drug delivery system using ultrafine particles of activated charcoal was developed and examined for its ability to adsorb mitomycin C (MMC) and to transport MMC to the lymph system. Satisfactory results were obtained. In animal experiments, serial sampling of thoracic duct lymph by cannulation and serial samplings of peripheral vein blood after injection of MMC-charcoal solution into the subserosal space of the intestinal wall were made to study the pharmacodynamics of the lymph-blood system through analysis of MMC regression curves. Clearance (K) and half-life (t1/2) are calculated from the formula; C(t) = C(t0) X e-kt, and compared with that of MMC-saline. Activated charcoal has a proven ability to transport MMC to the lymphatic system. With activated charcoal, MMC is retained for much longer in the lymph nodes than with saline. Congestion of the lymph system was produced by ligation of the thoracic duct in CH-40, with 25% prolongation of t1/2. In conclusion, these drug delivery systems are suitable for targeting chemotherapy at lymph node metastases, and it is proven that 1500 AA Mitsubishi ultrafine charcoal is a good carrier of drug and a slow drug-release material in the lymphatics. Minimal side effects are expected because of the constant low concentrations in the general circulation.

[Extended surgery for advanced colo-rectal carcinoma (stage IV and V)].

Two hundred fifty-five patients with colo-rectal carcinoma underwent operations in our department between January 1980 and December 1988. The five-year survival rate of stage IV patients (30 cases) was 58%, and the three-year survival rate of stage V patients (44 cases) was 8%. The study for the expression of blood group-related cancer-associated antigens (Lea, CA19-9, etc.) in colo-rectal cancers using immunohistological method and a series of mouse monoclonal antibodies revealed that the stromal staining pattern of CA19-9 means high malignancy with poor prognosis. Nineteen patients with locally invading rectal cancer were submitted to total pelvic exenteration with urinary diversion. The operative mortality rate was 5.3%. A determinate 5-year survival rate of 4.5 was achieved. Fourteen patients with local recurrent lesions of rectal cancer following abdominoperineal resection were submitted to pelvic exenteration combined with sacral resection. Two patients are alive disease free for longer than four years at this writing. This operation assures a better quality of life, lessening of symptoms, disease control and, in selected patients, a cure.