Evaluating benign and malignant bone and soft-tissue lesions with technetium-99m-MIBI scintigraphy

This study compares the ability of 201TI and 99mTc-MIBI to detect and assess tumor response to chemotherapy in malignant and benign bone and soft-tissue lesions.

METHODS

Forty-two patients with various bone and soft-tissue pathologies (29 malignant and 13 benign lesions) were studied with 201TI and 99mTc-MIBI. Planar 201TI scintigraphy was performed 15 min after injection of 111 MBq of 201TI. Within 1 wk of the 201TI study, radionuclide angiography with 600-740 MBq of 99mTc-MIBI was performed and planar imaging was done 15 min later.

RESULTS

In visual analysis, 31 of 42 patients showed similar uptake of both tracers, 8 showed more intense uptake of 99mTc-MIBI than 201TI and 3 showed more intense uptake of 201TI than 99mTc-MIBI. In quantitative analysis, similar 201TI and 99mTc-MIBI uptake ratios were obtained (1.96 +/- 1.25 versus 1.96 +/- 1.02, respectively; p = ns). The perfusion index derived from 99mTc-MIBI radionuclide angiography was higher than 99mTc-MIBI uptake ratio (2.33 +/- 1.23 versus 1.96 +/- 1.02, respectively; p < 0.005), but correlated well with 99mTc-MIBI uptake ratio (r = 0.75). In 11 patients with malignant tumors, 201TI and 99mTc-MIBI scintigraphy was repeated after chemotherapy and the uptake of both tracers was significantly suppressed in patients with complete response confirmed by histological evaluation. In patients with complete response (n = 3), the uptake ratio of both tracers was reduced by more than 50%, whereas, less than 20% reduction of uptake ratio was observed in patients with nonresponse (n = 6).

CONCLUSION

The ability of 99mTc-MIBI to detect malignant and benign bone and soft-tissue lesions and to assess tumor response to chemotherapy was comparable to that of 201TI. In addition, blood flow could be assessed by radionuclide angiography with 99mTc-MIBI. Technetium-99m-MIBI is a promising radiopharmaceutical for the evaluation of bone and soft-tissue lesions.

Disappearance of Ewing's sarcoma following bacterial infection: a case report

We report a patient with multiple metastases of Ewing's sarcoma in whom the tumor vanished after a bacterial infection. To the best of our knowledge, no comparable case with Ewing's sarcoma has been reported in the literature. The patient was a 17-year-old male who had an irregular destructive lesion of the left pelvis on radiologic examination. Pathologic examination of a biopsy specimen revealed Ewing's sarcoma. After the operation, a roentgenogram showed multiple spinal metastases with paraplegia. Despite initiation of chemotherapy, a subsequent bone scan showed several areas of increased uptake indicating multiple metastatic lesions. A fistula with purulent discharge opened at the operative site. While being treated with antibiotics and fistula irrigation, the fistula narrowed and his high fever subsided. During this period, radiologic examinations indicated that the multiple bone metastases had nearly disappeared. Nine years after the operation, the patient is alive without any evidence of tumor. We postulate that the antitumor activity in this patient resulted from the bacterial infection, and believe that this case supports continued consideration of immunotherapy for cancer.

[Evaluation of bone and soft tissue lesion using 99mTc-MIBI: comparison with 201Tl and the relation to chemotherapeutic effect]

Thirty-five patients with bone and soft tissue lesions were studied with 99mTc-MIBI and 201Tl to compare the uptake of two tracers. Planar images were obtained 15 min (early image) and 3 hr (delayed image) after the injection of both tracers. Images were evaluated visually and quantitatively using uptake ratio (lesion/background). In visual analysis, 23 of 35 patients showed similar uptake of both tracers, 9 showed more intense uptake of 99mTc-MIBI than 201Tl, and 3 showed more intense uptake of 201Tl than 99mTc-MIBI on early images. On delayed images, 21 of 32 patients showed similar uptake of both tracers, 3 showed more intense uptake of 99mTc-MIBI than 201Tl, and 8 showed more intense uptake of 201Tl than 99mTc-MIBI. In quantitative analysis, similar 201Tl and 99mTc-MIBI uptake ratios were obtained on early images. On delayed images, 99mTc-MIBI uptake ratios are less than that of 201Tl, but the difference was not significant. In some cases, 99mTc-MIBI accumulation was washed out on delayed images, therefore the early image is essential to evaluate 99mTc-MIBI accumulation. In all cases with the uptake ratios less than 1.20 on delayed 99mTc-MIBI images, chemotherapy was not effective. In malignant tumors, decreased uptake of 99mTc-MIBI accumulation on delayed images may indicate that chemotherapy is not effective. Delayed 99mTc-MIBI image may be a potential marker predicting chemotherapeutic effect in malignant bone and soft tissue tumors.

Vitamin C and copper interactions in guinea-pigs and a study of collagen cross-links

The purpose of this study was, first to explore metabolic interactions between Cu and ascorbic acid in guinea-pigs, particularly with respect to any possible disadvantages of high ascorbate in the presence of low Cu intakes, and second, to test the hypothesis that variations in ascorbate and/or Cu status might influence collagen cross-linking, either by inducing a change in the crosslinks: hydroxyproline ratio, or by inducing a change in the pyridinoline: deoxypyridinoline crosslinks ratio. Four matched groups, each of eight male weanling Dunkin-Hartley guinea-pigs, were maintained on purified diets containing either no added Cu, or 150 mg Cu/kg diet, and either 0.1 g or 30 g ascorbic acid/kg diet. They were then killed 8 weeks later, and the following indices were measured: body and organ weights; blood haemoglobin; adrenal ascorbate concentrations; Cu concentrations in plasma, liver and femur; superoxide dismutase (EC 1.15.1.1) activity in whole blood and liver; hydroxyproline, pyridinoline and deoxypridinoline in femur and in urine. The principal observations were: Cu intake significantly affected blood and tissue Cu concentrations and superoxide dismutase activity; and ascorbic acid intake significantly affected adrenal ascorbate levels and the deoxypyridinoline: pyridinoline cross-links ratio, especially in bone (femur). There was evidence of a significant interaction between ascorbate and Cu with respect to adrenal and plasma Cu concentrations, blood superoxide dismutase activity and body weights. We conclude that interactions between ascorbate and Cu at the functional level were present but modest, and that a new and potentially powerful functional index of ascorbate status may exist within the deoxypyridinoline:pyridinoline collagen cross-link ratio.

Total en bloc spondylectomy. A new surgical technique for primary malignant vertebral tumors

STUDY DESIGN

The study of seven patients with primary malignant or benign aggressive tumors who underwent a new aggressive surgical technique termed "total en bloc spondylectomy" is reported.

OBJECTIVES

To report a new surgical technique of total en bloc spondylectomy for complete, resection of primary spinal malignancy and for oncologic curability.

SUMMARY OF BACKGROUND DATA

The conventional approach for primary spinal malignancy is via intralesional piecemeal resection, and very few reports have described en bloc extralesional resectioning with histopathologically wide or marginal surgical margins.

METHODS

Total en bloc spondylectomy, consisting of en bloc laminectomy and en bloc corpectomy followed by anterior instrumentation with spacer grafting and posterior spinal instrumentation, was performed in five patients with primary malignant tumors and two patients with giant cell tumors. Patients were observed for 2 years to 6.5 years, except for one patient who died 7 months after surgery because of a mediastinal metastasis.

RESULTS

All patients, except one, attained significant clinical improvement after surgery with no major complications. Histologically, the margins were wide or marginal except for the pedicles, and occasionally the spinal canal and the posterior, where they were accepted to be intralesional. One patient died of metastasis that was not directly related to surgery itself. There was no local recurrence.

CONCLUSIONS

The advantages of total en bloc spondylectomy include resection of the involved vertebra(e) in two major blocs, rather than in a piecemeal pattern, and completion of the procedure during one surgical session posteriorly. The "total en bloc spondylectomy" offers one of the most aggressive modes of therapy for primary spinal malignancy.

Plasminogen activator inhibitor-1 accelerates lung metastasis formation of human fibrosarcoma cells

We have studied the effects of PAI-1 on the formation of metastasis using human fibrosarcoma cells and DNA transfection. A clone (1-3C), which shows low constitutive expression of PAI-1 and low metastatic potential to the lung, was selected from human fibrosarcoma cell line HT-1080. Newly-derived clones transfected with human PAI-1 cDNA showed a 3-5 fold increase in the antigen level of PAI-1. Further, these clones demonstrated a significant increase in both the number and incidence of lung metastases when inoculated into the tail vein of athymic mice. PAI-1 could be a prognostic marker and a target for understanding the physiology of metastasis, as well as for the treatment and prevention of hematogenous lung metastasis.

Childhood bronchial mucoepidermoid tumors

A very rare case of a childhood bronchial mucoepidermoid tumor is presented. A 4-year-old girl was hospitalized with prolonged pneumonia. Computed tomography of the chest showed a tumor with calcifications in the right upper lobe. Subsequently, the patient underwent right upper lobectomy. Histologically, the tumor was a low-grade mucoepidermoid tumor originating from the bronchus. Three years postoperatively there has been no evidence of disease. A review of the literature indicates that 30 cases of bronchial mucoepidermoid tumors in children have been reported. Symptoms result from associated bronchial obstruction. Children with recurrent or prolonged pneumonia should undergo aggressive diagnostic investigation by chest tomography or bronchoscopy. Appropriate therapy for childhood bronchial mucoepidermoid tumor is total resection of the lesion while sacrificing as little of the normal lung tissue as possible.

Effect of estrogen replacement therapy on hepatic triglyceride lipase, lipoprotein lipase and lipids including apolipoprotein E in climacteric and elderly women

Estrogen provides beneficial effects on hyperlipidemia in climacteric and elderly women. In this study of 68 women (37 to 67 years old), hepatic triglyceride lipase (HTGL), lipoprotein lipase (LpL) serum lipids and apolipoproteins were analyzed to investigate the effects of estrogen replacement therapy (ERT). After menopause, LpL, total cholesterol, low-density lipoprotein (LDL)-cholesterol, and apolipoprotein B increased. But ERT suppressed total cholesterol, LDL-cholesterol, apolipoprotein B, and especially apolipoprotein E in menopausal women. The mechanism was thought that ERT significantly suppressed HTGL, but LpL was not affected. Estrogen also increases hepatic LDL receptors and accelerates transfer of serum LDL-C (and TC). It was said that HTGL accelerates conversion of intermediate-density lipoprotein (IDL) to LDL. The suppression of HTGL by the ERT may decrease conversion of IDL to LDL and lower LDL-C (and TC). These estrogen's beneficial effects on lipids, may prevent the atherosclerosis. In addition, apolipoprotein E increases senile plaques in senile dementia-Alzheimer's type. The decrease in apolipoprotein E with ERT may be related to cognitive functions of elderly women.

Flavones with antibacterial activity against cariogenic bacteria

Methanolic extracts obtained from 13 plants were studied for their antibacterial activity against cariogenic bacteria. Among them, the extract from Artocarpus heterophyllus showed the most intensive activity. Serial chromatographic purifications offered two active compounds which were identified as 6-(3-methyl-1-butenyl)-5,2',4'-trihydroxy-3-isoprenyl-7-methoxy flavone and 5,7,2',4'-tetrahydroxy-6-isoprenylflavone. Both isolates completely inhibited the growth of primary cariogenic bacteria at 3.13-12.5 micrograms/ml. They also exhibited the growth inhibitory effects on plaque-forming streptococci. These phytochemical isoprenylflavones would be potent compounds for the prevention of dental caries.

Carcinogen-induced de novo methylation in c-myc exon I

During the response of N-methyl-N'-nitro-N-nitrosoguanidine (MNNG), methylation occurred at the Hpa II site of c-myc exon I, which is located downstream of the P1 initiation site, as evidenced by the assays of Hpa II-PCR. The Hpa II spite of the 5' flanking region did not undergo methylation. UV-irradiation also led to methylation in exon I. The extent of methylation increased depending on the dose of MNNG and UV. The results suggested that methylation takes place in transcriptionally active c-myc responsible for carcinogens and is caused by mechanisms different from that of alkylation in a specific CpG site. Possible contribution of methylation to less repair found in c-myc is discussed.

[Detection of PEBP2 beta/MYH11 fusion mRNA in acute myelomonocytic leukemia without marrow eosinophilia]

We present a 15-year-old woman with acute myelomonocytic leukemia without marrow eosinophilia, M4 in the FAB classification. She was admitted to our hospital with nausea and headaches. Upon admission, the leukocyte count was 284,000/microliters with 95% leukemic cells. The bone marrow aspirate was hypercellular with 74.8% blasts and 0.2% eosinophils. Leukemic cells were positive for myeloperoxidase and esterase staining. Initially, the karyotype of the bone marrow cells on admission was considered to be normal. However, the PEBP2 beta/MYH11 fusion transcript was detected in the bone marrow mononuclear cells by using the reverse transcriptase-polymerase chain reaction (RT-PCR). Reevaluation of karyotypes showed a t(16;16) (p13;q22) in the bone marrow cells. After achieving complete remission, she was treated with low-dose etoposide. Chromosome analysis showed a normal karyotype and no amplified chimeric transcripts were observed. This case indicates that the molecular analysis of PEBP2 beta and MYH11 genes is a useful tool to detect inv (16) and t(16;16) which were often difficult to find, and that leukemic cells from some cases of M4 without marrow eosinophilia have these chromosome abnormalities.

Identification of a novel protein (VBP-1) binding to the von Hippel-Lindau (VHL) tumor suppressor gene product

The tumor suppressor VHL gene product (pVHL), recently reported to bind to elongins B and C, is thought to regulate transcription elongation. To establish whether the VHL gene may have other functions, we here searched for additional cellular protein(s) that might bind to pVHL using a two-hybrid system and identified seven independent clones, including elongin C, but not elongin B. Three clones (unknown, imidopeptidase, and unknown) presumably bind to the N-terminal nonconserved region, whereas the four other clones [elongin C, the HIV tat-binding protein, the actin-binding protein Filamin (ABP280), and the HIBBJ46 (named VBP-1)] were found to bind to the wild-type pVHL but not to a C-terminal 156-amino acid deletion mutant. Interestingly, the HIV tat-binding protein and Filamin could bind to C-terminal 26-amino acid deleted pVHL, but elongin C and VBP-1 failed to do so. Thus, elongin C and VBP-1 require the C-terminal end of pVHL for binding. It was also established that epitope-tagged pVHL strongly forms complexes with VBP-1 in vivo using immunoprecipitation Western blotting analysis. VBP-1 was widely expressed in various cell lines tested, in which VHL mRNA can be detected. When the VBP-1 protein was solely expressed, it located to the cytoplasm and did not localize to the nucleus. However, when coexpressed with VHL, it can translocate to the nucleus. These results indicate that VBP-1 can form a complex with VHL protein in vivo and hence VHL affects the intracellular localization of VBP-1 protein.

A method for evaluating the cariogenicity of oral bacteria using radio-labelled synthetic hydroxyapatite

Radioactive hydroxyapatite was synthesized using 45Ca to evaluate the cariogenicity of oral streptococci. Discs prepared from it were suspended in media containing sucrose, then inoculated with Streptococcus mutans or Streptococcus sanguis. The radioactivity in the supernatant fluid was measured at specified time intervals. Released 45Ca in the supernatant fluids markedly increased in both species during the experimental period, while Strep. mutans showed much higher decalcification than Strep. sanguis. The present method would be useful for semi-quantitative evaluation of bacterial decalcification ability.

THE ILIZAROV METHOD IN THE MANAGEMENT OF GIANT-CELL TUMOURS OF THE PROXIMAL TIBIA

We have used the Ilizarov technique for the management of subarticular defects after the excision of giant-cell tumours in the proximal tibia in five patients. The defect was reconstructed with a segment of 5 to 6 cm obtained from the diaphysis of the affected tibia and by autogenous bone graft from the iliac crest. The newly developed defect in the diaphysis was reconstructed by distraction using the Ilizarov apparatus. Bone grafting at the docking site was performed soon after positioning the bone segments.

The mean length of the bone defect was 5.7 cm and the mean duration of external fixation was 233 days. The relative blood flow in the leg measured by 99mTc angiography increased by 1.7 to 2.3 times that of the control level during distraction and consolidation. When seen at a mean of 43 months all patients showed a normal range of motion in the knee and ankle with no collapse of the articular surfaces.

Urinary excretion of tetrahydro-beta-carbolines relating to ingestion of alcoholic beverages

Tetrahydro-beta-carbolines, formed from aldehydes and tryptamine, have been suggested as potential biochemical markers for alcoholism. The excretion of 1-methyl-1,2,3,4-tetrahydro-beta-carboline (MTBC) and 1,2,3,4-tetrahydro-beta-carboline (TBC) in human urine was studied to assess their possible origin. In urine collected after a drinking party, MTBC and TBC were excreted in significantly higher concentrations compared with sobriety. MTBC and TBC were contained in beer and wine at ng/ml levels, but not in distillate alcoholic beverages such as whisky, brandy, gin, etc. The urinary excretion of MTBC and TBC was elevated after drinking beer, whereas no change was observed after drinking whisky. When a human subject was orally administered with deuterated L-tryptophan together with drinking whisky, deuterated tryptamine was increasingly excreted in urine. However, no increase was found in urinary deuterated MTBC. These results indicate that the urinary excretion of MTBC and TBC associated with alcohol ingestion does not imply promotion of their in vivo formation, but the exogenous supply of MTBC and TBC by drinking alcoholic beverages containing them.

The Ilizarov method in the management of giant-cell tumours of the proximal tibia

We have used the Ilizarov technique for the management of subarticular defects after the excision of giant-cell tumours in the proximal tibia in five patients. The defect was reconstructed with a segment of 5 to 6 cm obtained from the diaphysis of the affected tibia and by autogenous bone graft from the iliac crest. The newly developed defect in the diaphysis was reconstructed by distraction using the Ilizarov apparatus. Bone grafting at the docking site was performed soon after positioning the bone segments. The mean length of the bone defect was 5.7 cm and the mean duration of external fixation was 233 days. The relative blood flow in the leg measured by 99mTc angiography increased by 1.7 to 2.3 times that of the control level during distraction and consolidation. When seen at a mean of 43 months all patients showed a normal range of motion in the knee and ankle with no collapse of the articular surfaces.

Suppression of the neoplastic phenotype by replacement of the Tsc2 gene in Eker rat renal carcinoma cells

The hereditary renal carcinoma (RC) in the rat, originally reported by R. Eker in 1954, is an excellent example of a Mendelian dominantly inherited predisposition to a specific cancer in an experimental animal. Recently, we have identified a germline mutation of the sclerosis (Tsc2) gene in the Eker rat (Nature Genetics 9, 70-74, 1995), suggested to be a novel tumor suppressor gene, fitting Knudson's two-hit hypothesis. In this study, the effect of wild-type Tsc2 gene expression in Eker RC cells was tested using a tetracycline-responsive promoter system. Transfection and expression of a exogenous Tsc2 gene affected both cell morphology and growth rate. This demonstration of suppression of the neoplastic phenotype provides direct evidence for an essential role of the Tsc2 gene in tumorigenesis.

[Intraoperative use of plasma-derived activated factor VII (F VII a) in a hemophilia A patient with inhibitors]

We treated a 1-year 9-month-old boy with severe hemophilia A who developed high level of F VIII inhibitor. A placement of an implantable intravenous access device was scheduled under general anesthesia. After a slow induction using oxygen, nitrous oxide and sevoflurane, a peripheral venous line was placed and plasma-derived F VII a was infused. A catheter was inserted via the jugular vein to the SVC and it was connected to the device placed subcutaneously in his right chest wall. The peroperative blood loss was slight, and anesthesia and surgery went uneventfully.

Presence of potent transcriptional activation domains in the predisposing tuberous sclerosis (Tsc2) gene product of the Eker rat model

The Eker rat hereditary renal carcinoma is an excellent example of Mendelian dominant predisposition to a specific cancer in an experimental animal. We recently reported that a germline insertion in the rat homologue of the human tuberous sclerosis gene (TSC2) gives rise to dominantly inherited cancer in the Eker rat model, as well as a tumor suppressor nature for the Tsc2 gene function. We also showed a strong conservation between the rat and human gene products. The molecular function of the Tsc2 gene product (called "tuberin" in the human case) is not yet understood, although it contains a short amino acid sequence homologous to ras family GTPase-activating proteins (Rap1GAP). Here, we describe transcriptional activation domains (AD1 and AD2) in the carboxyl terminus of the Tsc2 product (in exons 30 and 32 and exon 41, respectively). The Eker insertional mutation (intron 30) disrupts their transcriptional activity. Whereas a COOH-terminal truncated Tsc2 protein was localized in the nucleus, the full-length protein is found predominantly in the perinuclear region of cytoplasm. The present demonstration of transcriptional activation domains in the Tsc2 gene provides clues for studying its role in renal carcinogenesis.