A 74-year-old man had been taking warfarin for atrial fibrillation, but warfarin was discontinued due to upper gastrointestinal bleeding. One week later, left hemiplegia occurred, and cranial magnetic resonance imaging revealed multiple cerebral infarctions. Systemic examination revealed thrombi in both atria as well as duodenal cancer. Because all of the thrombi in both atria were larger than 30 mm in diameter, the risk of embolism or sudden death was assumed to be high. Although the use of cardiopulmonary bypass for cancer patients is controversial, bilateral atrial thrombectomy was performed 4 weeks after cerebral infarction onset because reasonable survival duration was expected with surgery for duodenal cancer after thrombectomy and further treatment. The timing of and indications for surgery in this case are discussed.

It is not uncommon for edema in the end stage of advanced cancer to be caused by nephrotic syndrome (NS) as well as by cachexia, hypo-proteinemia due to malnutrition, or lymphedema. Such edema not only causes patients' quality of life (QOL) to be deteriorate, but may also result in earlier death in the absence of accurate diagnosis and treatment. We report a case of nephrotic syndrome with advanced uterine cancer, in which the patient's QOL was greatly improved by the accurate and timely diagnosis and treatment of NS. A 65-year old woman suffering from recurrent uterine cancer (lung and brain metastases) was admitted as an emergency due to deterioration of her general condition. Edema of both legs was severe, and laboratory findings (TP 5.0 g/dl, ALB 1.3 g/dl, T-Chol 369 mg/dl, proteinuria 3+) at the time of admission met the diagnosis criteria for NS rather than cachexia. We first administered albumin to stabilize circulation, and started treatment with prednisolone and cyclosporine, which greatly improved her general condition and edema of her legs. Subsequently, NS repeatedly improved and worsened and the tumors gradually progressed. The patient died of multiple organ failure induced by disseminated intravascular coagulation (DIC) at 81 days after admission. NS caused by malignancy is not uncommon. In general, however, such cases of NS are associated with solid tumors, such as gastrointestinal and lung cancer. NS caused by uterine cancer is very rare. We suggest that NS should be borne in mind in addition to cachexia, hypo-proteinemia or lymphedema as a possible cause of edema in the end stage of advanced cancer. Palliat Care Res 2011; 6(1): 316-323

OBJECTIVETo study the effect of anti-progression activity of edible plants using urokinase as the biomarker.

METHODSBased on the assay of urokinase activity with peptide of Glu-Gly-Arg as the reaction substrate, extract of 25 fruits and 37 vegetables and water extract of tea were reacted against urokinase activity after Spectrozyme UK [carbobenzyl-1-gamma-Glu(alpha-t-BuO)-Gly-Arg-rho-nitroanilide. 2C2H5OH] was added and the residual urokinase activity was measured by the microplate photometer.

RESULTSAbout half of the fruit and vegetable samples showed urokinase inhibitory activity (UIA) at 20% or more and among them lemon, kiwi-fruit, peas, spinach and pumpkin showed effects over 80%, while garlic, radish, Japanese butterbur, garland chrysanthemum, celery, plum, pineapple and grape ranged between 50% and 79%. Average UIA of 51 kinds of tea was 83.2% and among them 28 kinds showed UIA over 90% and other 20 kinds of tea ranged from 70% to 89%. Green tea showed inhibitory effects on urokinase activity more powerful than black tea and Oolong tea. On the other hand, vegetable showed various UIA with different ways of processing. Comparing the effects of various solvents, garlic extracted with methanol, spinach with ethyl acetate, and pumpkin and radish with water showed highest UIA.

CONCLUSIONPopular fruits, vegetables and tea in daily life could inhibit urokinase activity and may be helpful in the prevention of malignant tumor formation.

Fruit ; chemistry ; Plant Extracts ; pharmacology ; Plants, Edible ; chemistry ; Tea ; chemistry ; Urokinase-Type Plasminogen Activator ; antagonists & inhibitors ; metabolism ; pharmacology ; Vegetables ; chemistry