Biomedical subjects
Publications and source records attributed to N Tsukamoto.
The 11th well-documented case of malignant melanoma, arising in a cystic teratoma of the ovary, is described. The melanoma which recurred 4 months after surgery responded completely to immunochemotherapy.
Sixty-one patients with cancer of the uterine cervix received pretreatment laparotomy before the radiotherapy. As an operative procedure, several hemostatic clips were put on the serosal surface of the uterine wall in order to visualize the uterine contour in the localization X-ray films. By this method, six patients among them were proved to have uterine perforation at the time of small source insertion.
A case of adenocarcinoma of the descending colon during pregnancy is reported. The patient presented with bilateral large ovarian tumors in pregnancy, and surgery was performed for a presumed ovarian cancer. Only a small, 1 X 1-cm primary focus of adenocarcinoma was found in the resected descending colon. The association of pregnancy and colon cancer above the peritoneal reflection is rare, and only 20 such patients have previously been reported.
Changes in urinary PGE2 and PGF2 alpha excretion in chronic liver diseases were observed in relation to renal hemodynamics and sodium balance. After equilibration on a 110-170-meq sodium diet, daily urine collections were analyzed for PGE2 and PGF2 alpha by a new extraction and radioimmunoassay method. PGE2 was significantly greater in cirrhotics than in healthy subjects and in chronic hepatitis. The value was greater in cirrhotics with ascites than in those without ascites (p less than 0.05). PGF2 alpha did not differ among the groups. In cirrhotics PGE2 was correlated negatively with creatinine clearance (Ccr)(r = -0.76, p less than 0.001). After administration of 200 mg indomethacin, a significant fall in Ccr was seen only in cirrhotics with ascites. The percentage fall in PGE2 after indomethacin correlated with that in Ccr (r = 0.89, p less than 0.05) and with that in urinary sodium excretion (r = 0.68, p less than 0.02). These results suggest that PGE2 is essential in the maintenance of renal function in liver cirrhosis with ascites.
Five episodes of spinal cord compression (SCC) in four patients with gynecological malignancy are described. Two patients had a recurrent cervical cancer, one had a recurrent uterine sarcoma, and one had a primary ovarian cancer. All presented with back pain, and the site of compression was at the thoracic spine. Three patient were treated with radiotherapy, and one underwent decompression laminectomy followed by radiotherapy. One patient improved, but the other three did not. SCC is an oncologic emergency, which should be borne in mind by all physicians who take care of cancer patients.
Thirty previously untreated patients with epithelial ovarian carcinoma were treated with cisplatin and adriamycin (PA). Of eight evaluable patients, six were responders (two CRs and four PRs). The three-year survival rates were 83% for stage I, 67% for stage II, 50% for stage III, and none for stage IV. Toxicities included moderate myelo-suppression, mild nephrotoxicity, alopecia, and severe vomiting in almost all patients. Patients with residual lesions smaller than 2 cm had excellent prognosis when PA was given for more than five courses. Patients with residual lesions larger than 2 cm, however, had poor prognosis irrespective of the number of courses. No specific relation between histological grade and prognosis could be found. From the present data, aggressive cytoreductive surgery followed by PA therapy repeated more than five times is recommended for achieving a good outcome in the treatment of epithelial ovarian carcinoma.
We report 28 cases of malignant disease in pregnant women. They were divided into 14 cases of intrapelvic tumors and 14 of extrapelvic tumors. The intrapelvic tumors were cervix cancer in nine and ovarian cancer in five, while the extrapelvic tumors were brain tumors in three, maxillary cancer in one, tongue cancer in one, pharyngeal cancer in one, breast cancer in one, gastric cancer in two, osteosarcoma in one Hodgkin's lymphoma in one, and leukemias in three. The prognoses of the patients with intrapelvic tumors were relatively good. But those of extrapelvic diseases were poor.
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Twenty cases of gestational trophoblastic disease in women aged 50 or more are reported. The lesions were 7 hydatidiform mole (35%), 8 invasive mole (40%), and 5 choriocarcinoma (25%). The most common presenting symptom was abnormal vaginal bleeding. Three choriocarcinoma patients were postmenopausal and all of them had choriocarcinoma. None of the patients with hydatidiform mole or invasive mole died of the disease, but 4 of 5 choriocarcinoma patients died of the disease. Because of the high rate (56.3%) of malignant sequelae after molar evacuation, a primary hysterectomy for the treatment of hydatidiform mole in this age group is recommended. It is important to maintain a high level of suspicion for the diagnosis of gestational trophoblastic disease in the elderly women.
This report describes a case of recurrent and metastatic endolymphatic stromal myosis (ESM), which showed good response to progestin therapy. Metastatic lung nodules regressed after medroxyprogesterone acetate (MPA) treatment, recurred while MPA was stopped, and disappeared again when MPA was restarted. The levels of estrogen and progesterone receptors measured in the resected tumor amounted to 79.5 and 310 fmole/mg protein, respectively. Sex steroid hormone dependency of ESM was reviewed in the literature.
Three patients with advanced and recurrent endodermal sinus tumor (EST) of the ovary were treated with modified vinblastine, actinomycin-D, and bleomycin (VAB-3) regimen. Serum alpha-fetoprotein (AFP) levels were monitored for all patients during and after therapy. In all patients a clinical response was achieved. In one stage IV patient with huge multiple liver metastases complete response was attained and she is free of disease following secondlook larparotomy. In other two patients, one stage IV and another recurrent, with large liver metastases, partial responses were achieved with normalization of serum AFP. Serum AFP monitoring is valuable for the management of EST, but a negative AFP titer does not eliminate the possibility of persistent or recurrent disease. The VAB-3 combination, previously found effective in metastatic nonseminomatous testicular cancer, is also effective in advanced and recurrent EST of the ovary.
Between 1978 and 1983, one hundred and forty-six patients with CIN I-III were treated with the carbon dioxide laser and 129 have been followed for 6 to 58 months. The remission rate was 92.2% after one treatment and 98.4% after two treatments. All persistent lesions were detected within 8 weeks after treatment. After confirmation of remission, 4 patients (3.1%) developed recurrence of CIN at an average of 37 months after treatment. The CO2 laser therapy is safe, effective, and cost saving for the patient, but a certain rate of recurrence is to be expected and the necessity of a long-term follow-up is stressed.
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Two hundred fifty-five cases of International Federation of Gynecology and Obstetrics (FIGO) Stage Ib, IIa, and IIb cases of cervical cancer were analyzed following radical surgery with regard to the extent of invasion into vagina, parametria, and pelvic lymph nodes. Restaging was carried out based on the findings. Discrepancies were found between FIGO stages and the actual extent of the disease, particularly in Stage IIb. Among 99 cases of Stage IIb, only 42.4% were correctly staged. The 5-year disease-free survival by FIGO and postsurgical stagings were, respectively: Ib, 88.4% and 87.0%; IIa, 85.2% and 95.0%; IIb, 70.7% and 62.3%. Prognostic significance in the pathologic examination of operated materials was demonstrated when there were deep stromal invasions of cancer cell or parametrial invasions or pelvic lymph node metastases. When cancer was present in both of the parametrium and pelvic lymph nodes, the prognosis of the patient worsened (5-year survival rate, 41.4%).
Immunoreactive substance P (ir SP)-containing neurons were examined in rat hypothalamus. In untreated males, few if any ir perikarya were found in the arcuate nucleus, but after intraventricular colchicine administration, many appeared not only in the arcuate nucleus but also in the premammillary region, posterior hypothalamic, ventromedial, dorsomedial, subthalamic and paraventricular nuclei, and zona incerta. This was also the case in females treated with colchicine on the second day of diestrus. In untreated females, perikarya were seen only in the arcuate nucleus, varying in number and ultrastructure during the estrous cycle and being maximal in number in proestrus and estrus. The perikarya possessed well-developed Golgi bodies and lamellar bodies composed of many closely apposed cisternae of endoplasmic reticulum in proestrus, and showed stacks of two or three cisternae of endoplasmic reticulum as well as lysosomes in estrus. In diestrus, the perikarya had only a few granulated vesicles and fragmental cisternae of endoplasmic reticulum. In the perikarya of colchicine-treated males, many granulated vesicles and lysosomal bodies were noted. These findings suggest that, among the widely distributed SP neurons in the hypothalamus, some in the arcuate nucleus are involved in the hypothalamic-hypophysial-gonadal axis.
A 40-year-old female with ovarian cancer being treated with daily oral cyclophosphamide developed fatal interstitial pneumonitis. Autopsy did not show any evidence of ovarian cancer. The review of the literature revealed eight reported cases of cyclophosphamide-induced interstitial pneumonitis and fibrosis. The case is reported to alert gynecologists to this rare but lethal complication of cyclophosphamide.
A case of verrucous carcinoma of the uterine cervix was reported with a long-term follow-up and close observation. The patient was a 73-year-old, Japanese female, who had a suspicious Papanicolaou smear on routine examination. The cervix was replaced by a papillary mass, which was diagnosed as benign papilloma. The patient was followed every 6 months with cytology, colposcopy, and punch biopsy. No cytologic or microscopic diagnosis of invasive squamous cell carcinoma was made during the entire follow-up period. Total abdominal hysterectomy and partial vaginectomy were performed after 6 1/2 years' follow-up, and the tumor was finally diagnosed as verrucous carcinoma. The patient is alive and well 4 years after the operation.