Expression of SPARC in tongue carcinoma of stage II is associated with poor prognosis: an immunohistochemical study of 86 cases.

SPARC (secretory protein acidic and rich in cysteine), also known as osteonectin or BM-40, associates with progression in various kinds of tumors. We have examined whether SPARC expression can be a prognostic marker for patients with head and neck squamous cell carcinomas (HN-SCC). We examined immunolocalization of SPARC in 86 clinical specimens of tongue carcinoma. Although there was no correlation between SPARC positivity in the tumor cells and tumor stages, the 5-year overall survival rate was significantly lower in the SPARC positive cases (28.6%) than in the SPARC negative cases (91.7%), confined to stage II patients (p < 0.001, Wilcoxon test). Additionally, in stage II cases (n = 3), frequency of the postoperative metastasis was significantly higher in SPARC positive cases (5/8, 62.5%) than in the negative cases (1/15, 6.7%) (p < 0.01, chi2 test). Together with these results, SPARC can be a beneficial prognostic marker for the stage II tongue carcinoma, of which clinical outcomes are sometimes difficult to predict.

Inostamycin suppresses vascular endothelial growth factor-stimulated growth and migration of human umbilical vein endothelial cells.

Angiogenesis involves multiple steps including proliferation and migration of endothelial cells. In the present study, we determined the effect of inostamycin (an inhibitor of phosphatidylinositol synthesis) on vascular endothelial growth factor (VEGF)-induced proliferation and migration of human umbilical vein endothelial cells (HUVECs). Inostamycin significantly attenuated both VEGF-induced proliferation and migration of HUVECs. Inostamycin inhibited activation of mitogen-activated kinases (ERK and p38) and elevation of cyclin D1 induced by VEGF. These data suggest that inostamycin reduced both proliferation and migration of HUVECs by targeting ERK-cyclin D1 and p38, respectively.

[Two head and neck cancer patients who responded to chemotherapy consisting of only TS-1].

We report two head and neck cancer patients who responded to TS-1. Case 1, a 52-year-old man was admitted to our department a diagnosis of supraglottic laryngeal cancer (T3N2cM0) on January 25, 2000. Concurrent chemoradiotherapy consisting of 2 courses of chemotherapy and radiation therapy at 70.2 Gy was administered. After the treatment, a biopsy showed a remaining cancer in the primary lesion. Since the patient refused to undergo surgery, the patient was followed up at the outpatient clinic using UFT at 400 mg/day. Because pulmonary metastasis was detected by chest CT, administration of TS-1 was started. TS-1 was administered at the conventional dose of 120 mg/day for 4 weeks followed by a 2-week rest. According to a CT conducted after 2 courses, the mass in the lung field disappeared and the clinical outcome was judged to be a CR. The TS-1 administration is still continuing, and the patient's condition also remains a CR. Case 2 was a patient with highly-differentiated adenocarcinoma in the ethmoid sinus (T3N2bM0). The patient was inoperable and was given radiation therapy of 64.8 Gy. Because of no change of the tumor after radiotherapy, TS-1 was administered at 60 mg x 2/day for 4 weeks followed by a 2-week rest. After TS-1 was administered for 3 courses, a CT showed a remarkable regression of the tumor resulting in a PR for the primary and the neck lesion. Upper gastrointestinal endoscopy during the 4th course detected a gastric ulcer of the A1 stage, and the patient was immediately admitted to the hospital. The ulcer was an adverse reaction of grade 3, which was improved by conservative therapy. TS-1 was restarted with a dose of 100 mg/day on April 11. No particular adverse reaction has been observed since then. The patient has received 13 courses of TS-1 and is still receiving TS-1. No clear tumor has been observed, and the clinical outcome is considered to be a CR. TS-1 is considered to be an excellent oral anticancer drug in terms of its anti-tumor effect and the patient's QOL.

A study of the early stage of Dysphagia in amyotrophic lateral sclerosis.

In amyotrophic lateral sclerosis (ALS) patients, dysphagia eventually occurs independent of time of onset. We studied dysphagia conditions in the early stage of ALS, principally at the oral phase. Videofluoroscopic and manometric studies were conducted on 11 patients (5 males and 6 females, age range = 47-82 years) who were diagnosed at our Neurology Clinic as having ALS. All patients were able to ingest orally. Swallowing scores on the ALS severity scale were from 10 to 5. In the oral phase of swallowing, abnormal movements of the anterior and/or posterior tongue were recognized in 8 cases. Dysphagia severity tended to be particularly influenced by dysfunction of the posterior tongue. Manometric studies were almost normal in all cases except one. These results suggested that the early stage of dysphagia in ALS was mainly caused by oral dysfunction, and the oral phase disorders began in some cases with a decreased function of bolus transport at the anterior part of the tongue, and in other cases with a deteriorated function of holding the bolus at the posterior part of the tongue. In conclusion, the tongue function of holding the bolus in the oral cavity mainly affects the severity of the early stage of dysphagia in ALS.

[Attempt to introduce critical paths at a university hospital].

In Japan there is a possibility that diagnosis related group/prospective payment system (DRG/PPS) will be introduced as one means to decrease medical expenses in the future. Recently, measures to improve medical services, including approaches to improving medical care represented by evidence based medicine (EBM) and disclosure of medical information including clinical records, have been seen. The authors department is attempting to introduce clinical paths as one tool to cope with such changes in medical care circumstances. Using the tabulations of patients over the past year and major diagnostic classification (MDC) with the Japanese edition of DRG/PPS serving as a guide, we have prepared critical paths for ten diagnosis and treatment groups consisting of sudden deafness, tonsillectomy, laryngo-microsurgery, endoscopic sinus surgery, tympanoplasty, removal of parotid gland tumor, neck dissection, total laryngectomy, total pharyngo-laryngectomy and operation for tongue-oropharyngeal cancer. We report herein on the present status of the introduction of these critical paths at our department.