Clinical and histopathologic examination of renal allografts treated with tacrolimus (FK506) for at least one year

BACKGROUND

We clinically and pathologically analyzed renal allografts from 1 9 renal transplant patients treated with tacrolimus (FK506) for more than 1 year.

METHODS

Twenty-six renal allograft biopsy specimens from 1 9 renal transplant patients who underwent transplantations between 1991 and 1993 were evaluated. Thirteen biopsies were performed from stable functioning renal allografts with informed consent (nonepisode biopsy) and the other 13 were from dysfunctional renal allografts with a clinical indication for biopsy (episode biopsy).

RESULTS

The main pathologic diagnoses (some overlap) were acute rejection (AR; n = 4), chronic rejection (CR; n=5), AR+CR (n =4), recurrent IgA nephropathy (n =5), normal findings (n =2), minimal-type chronic FK506 nephropathy (n = 9), and mild-type FK506 nephropathy (n = 11). Of the nonepisode biopsies, 7 and 4 biopsies showed minimal-type and mild-type chronic FK506 nephropathy, respectively. Chronic FK506 nephropathy consisted of rough and foamy tubular vacuolization (5 biopsies), arteriolopathy (angiodegeneration of the arteriolar wall; 20 biopsies), focal segmental glomerulosclerosis (4 biopsies) and the striped form of interstitial fibrosis (11 biopsies). The serum creatinine levels of patients in the mild-type chronic FK506 nephropathy group, which included 7 episode biopsies, were statistically higher than those in the minimum-type chronic FK506-nephropathy group (P< 0.001).

CONCLUSIONS

This study demonstrates that chronic FK506 nephropathy consists primarily of arteriolopathy manifesting as insudative hyalinosis of the arteriolar wall, and suggests that mild-type chronic FK506 nephropathy is a condition which may lead to deterioration of renal allograft function.

Radiological and laboratory features of infantile cortical hyperostosis. A case report

We describe a boy aged nine months with infantile cortical hyperostosis in association with cystic fibrosis. Symmetrical periosteal thickening was present in the clavicles, ribs, femora, humeri, ulnae and radii. Periosteal hyperostosis of the humerus developed in association with an increase in the levels of serum alkaline phosphatase a month before the appearance of hyperirritability and soft tissue swelling about the hip joints. The condition gradually resolved during the following eight months.

Morphological findings in non-episode biopsies of kidney transplant allografts treated with FK506 or cyclosporine

We conducted an analysis of biopsy specimens of non-episode renal allografts from patients treated with tacrolimus (FK506) or cyclosporine (CsA) to evaluate chronic drug-induced nephropathy in stable allografts. A total of 38 biopsy specimens from stable functioning renal allografts were examined. The patients had been treated with FK506 (n = 16) or CsA (n = 18) as main immunosuppressant for 0.3 to 7.4 years. Of the 38 biopsy specimens, 15 showed mild drug-induced arteriolopathy (hyalinosis or insudative change of arterioles and small arteries) with striped-form interstitial fibrosis, 10 showed minimum interstitial cellular infiltration (borderline rejection), 2 showed IgA nephropathy, 4 showed evidence of chronic rejection (transplant nephropathy) and 12 showed no abnormal findings. Of 34 renal allograft biopsy specimens with stable function, 22 (65%) showed pathological evidence of drug-induced nephropathy. There were no significant qualitative or quantitative differences between FK506- and CsA-associated nephropathy.

Familial prostate cancer in four brothers

We identified a family of 4 brothers with prostate cancer. The proband was the second son who was seen at the Department of Urology, Gunma University, Gunma, Japan, in May 1995, with a chief complaint of dysuria. The serum level of PSA was high, and a prostate needle biopsy revealed a moderately-differentiated adenocarcinoma. Subsequently, a total prostatectomy was performed. The family history revealed that the fourth son had been under treatment at the Saitama Cancer Center Hospital for prostate cancer since 1994. Therefore, the other 2 brothers became healthy male family members of the familial prostate cancer line, and their serum PSA levels were examined after obtaining their informed consent. Both had a high serum PSA level and biopsies revealed moderately-differentiated adenocarcinomas in both. Human leukocyte antigen class II gene typing was conducted on 3 of 4 brothers and 4 healthy family members who gave informed consent, and revealed the DRB1*0901-DQB1*0303 haplotype in the first, second and third sons. Familial prostate cancer is well documented in Europe and the US where the incidence of prostate cancer is high, but this is the first report of prostate cancer in 4 brothers in Japan.

A comparative study of FK506 granules and capsules in renal transplant recipients

Nine renal transplant recipients in stable systemic condition on FK506 capsules were converted to FK506 granules in order to investigate the safety, efficacy, and pharmacokinetics of the granular formulation of FK506. The study period for the administration of FK506 granules was 4 weeks, and in principle, the oral dose was the same as that of the FK506 capsules. Renal graft function remained stable and no rejection signs were noticed while the patients were taking the granules. The area under the blood concentration-time curve (AUC), the maximum blood level (Cmax), and the time to reach Cmax (Tmax) after FK506 capsules and FK506 granules were, respectively, 93.1 +/- 66.4 and 97.0 +/- 89.1 ng.h/ml (P = 0.81), 12.7 +/- 7.1 and 15.2 +/- 11.7 ng/ml (P = 0.39), and 2.0 +/- 1.7 and 1.3 +/- 0.6 h (P = 0.29). The mean trough blood level during FK506 medication was 4.25 +/- 3.42 and 4.02 +/- 3.83 ng/ml, respectively, for the capsules and the granules. FK506 granules, a new formulation, showed an efficacy comparable to that of the FK506 capsular formulation.

Periosteal ganglion of the radius: a case report

We report a case of 43-year-old female with a periosteal ganglion arising in the right radius. Plain radiographs showed thick and sparse spicula with shallow and irregular cortical erosion, which suggested periosteal ganglion. Magnetic resonance (MR) imaging revealed a well circumscribed homogeneous lesion with low signal intensity on T1-weighted images and high signal intensity on T2-weighted images. No apparent enhancement observed after gadolinium injection suggested that the lesion was cystic. At operation, gelatinous material was removed together with the spicula, the surface of the cortex and the overlying periosteum. There was no clinical evidence of recurrence after three years of surgical treatment. MR imaging was thought to be useful to confirm the diagnosis of periosteal ganglion.

Familial prostate cancer in Japan

BACKGROUND

Familial prostate cancer has been studied in Europe and the United States. This study was conducted to clarify the clinical features and incidence of the human leukocyte antigen (HLA) in familial prostate cancer in patients seen at hospitals in Japan.

METHODS

The age at diagnosis, clinical stage, histologic differentiation, prognosis, cause of death and family history were compiled from 43 patients from 20 families with familial prostate cancer (group F) and compared in patients with sporadic prostate cancer (group S). In addition, HLA class II gene typing was performed in 17 patients from 11 families with familial prostate cancer (group F') and their healthy family members (15 males and 25 females).

RESULTS

The age at diagnosis was significantly lower in group F patients (P< 0.001), but neither clinical stage nor prognosis differed between group F and group S, yet the incidence of moderately differentiated adenocarcinoma was significantly higher in group F (P< 0.01 ). There were no historical factors that were specific for group F patients. The frequency of HLA-DRB1 *0901 and *1201 alleles was significantly higher in group F' patients than in group J (the frequency of alleles in 1216 Japanese people attending the 11th Japan HLA Workshop), but not between group F' and their healthy male family members.

CONCLUSION

There were no significant differences in clinical parameters between group F and group S, except that the age at diagnosis was lower in group F patients, and that the frequency of several HLA class 11 alleles was significantly higher in patients with prostate cancer. In men with a family history of prostate cancer, examinations for early detection of prostate cancer should begin at a young age.

Myositis ossificans in the tip of the thumb: a case report

A case of a myositis ossificans occurring in the distal portion of the finger is reported. An 18-year-old female noticed a small nodule in the tip of the left thumb for 11 months. Plain radiographs showed calcified shadow and there was a radiolucent zone between the mass and the distal phalanx. The excised mass was diagnosed as myositis ossificans. To our best knowledge, there has been no report of a myositis ossificans in the tip of the finger in literature.

Bilateral coronary ostial stenosis and aortic regurgitation due to syphilitic aortitis

Coronary ostial stenosis in otherwise normal coronary vessels, is a rare complication of syphilitic aortitis, and most of the cases are found at autopsy. We report here a case in which bilateral coronary ostial stenosis and aortic regurgitation due to syphilitic aortitis was diagnosed; coronary artery bypass graft and aortic valve replacement were then performed. The macroscopic finding and the histopathological examination of the ascending aorta revealed the presence of syphilitic aortitis. It is important to note that syphilis is one of the causes of coronary ostial stenosis in young adults associated with aortic regurgitation.

The long-term efficacy and tolerability of the new anti-inflammatory agent zaltoprofen in rheumatoid arthritis

This paper reports on a non-comparative multicentre study designed to assess the usefulness of the non-steroidal anti-inflammatory agent zaltoprofen in the long-term treatment of rheumatoid arthritis. The efficacy and safety of zaltoprofen in the long-term treatment of rheumatoid arthritis were evaluated on the bases of changes of symptoms and presentation signs in the patients including the following: averaged bilateral grip strength, blood sedimentation rate, the duration of morning stiffness, joint pain for Lansbury scoring, restriction of activities of daily living (ADL) and pain score, and on patients' impressions at each hospital on the first day of attendance and then at 6 and 12 months after the start of administration of zaltoprofen, in a total of 46 patients. Overall improvements were recorded as 'marked' in 9%, 'moderate' or better in 60%, 'slight' or better in 80%, 'no change' in 17% and 'worse' in 3%, after 12 months' treatment. The overall safety was recorded as 'safe' in 86% and 'almost safe' or better in 97% after 12 months' treatment. On the basis of these results it can be concluded that, in the long-term treatment of rheumatoid arthritis, zaltoprofen is a well-tolerated and safe non-steroidal anti-inflammatory agent.

Flow cytometrical and genotypic analysis of primary non-Hodgkin's lymphoma of bone

Primary malignant lymphoma of bone presents both diagnostic and therapeutic problems. No previous study has addressed the use of flow cytometry in the immunophenotypic evaluations of bone lymphomas. A 41-year-old Japanese female presented with a large lytic lesion in the right femur. Biopsies from the lesion were examined by light microscopy, immunohistochemistry, 3-color flow cytometry and Southern blotting. Microscopic examination showed a diffuse, noncleaved large cell lymphoma. The lymphoid cells were positive for mature B cell antigens and the phenotype was: CD5-, CD10-, CD19+, 20+, CD22+, IgG+, IgA-, IgM-, kappa-, lambda+, CD1-, CD2-, CD3-, CD4-, CD7-, CD8-. Southern blot analysis revealed rearranged bands on both heavy- and lambda light-chain genes, in contrast to germline configuration on T cell antigen receptor (beta, gamma and delta) genes. Flow cytometry, in conjunction with morphologic and other molecular techniques, can provide a rapid and accurate means of diagnosing primary lymphoma of bone. In addition, the capabilities of flow cytometry to assess cell properties/constituents can be utilized in detailed analysis of adhesion molecules and activation antigen which may lead to better prediction of the prognosis of this group of lymphomas, and may provide further important data for the therapeutic decision making process.

Diffuse lipomatosis: imaging features

A case of diffuse lipomatosis is reported. A 54-year-old man presented with a large mass in the left gluteal region. Plain radiographs showed hyperostosis of the phalanx of the left third toe. The diagnosis was aided by magnetic resonance imaging and computed tomography which clearly demonstrated a diffuse overgrowth of fatty tissue in the left buttock and the extremity involving the subcutaneous and gluteal muscular tissue.

[A case of recurrent IgA nephropathy following renal transplantation under tacrolimus (FK506)]

We report a case of recurrent IgA nephropathy following renal transplantation under tacrolimus (FK506). A 23-year-old female who had been diagnosed with IgA nephropathy was transplanted from her HLA two-mismatched mother under tacrolimus, prednisolone and azathioprine. Two years after transplantation, suddenly she noticed macroscopic hematuria. At that time, functional renal deterioration (serum creatinine: 2.3 mg/dl) and mild proteinuria were observed. Allograft biopsy disclosed acute cellular rejection. She was administered a bolus injection of methylprednisolone, 15-deoxyspergualin and anti-lymphocyte globulin. However, the response to the treatment was poor. A transplant biopsy revealed focal segmental glomerulosclerosis by PAS staining and granular IgA and C3 deposits on immunofluorescence examination. There was no sign of acute rejection and toxicity by tacrolimus. We diagnosed recurrent IgA nephropathy. At the present time, she has normal urinalysis and renal function is stable (serum creatinine: 1.9 mg/dl). No proteinuria was observed after total dosage of immunosuppressants was increased. Although recurrence of IgA nephropathy in renal allograft is frequent, allograft dysfunction is rare. However, IgA nephropathy has several types with different prognosis. For functional renal deterioration after renal transplantation, we should consider not only an acute rejection or the toxicity of immunosuppressants but also recurrent nephropathy.

Expression of CD34 in glomus tumors

Immunohistochemical studies were performed in order to characterize glomus tumors. In all cases the glomus tumor cells stained positively for smooth muscle actin. In half of six cases, the glomus tumor cells weakly expressed desmin. They were not reactive with Ulex europaeus agglutinin-I and anti-Factor VIII-related antigen, whereas the only endothelial cells were reactive with them. The tumor cells as well as vascular endothelial cells amongst the tumor cells expressed CD34 in five of the cases.

Expression of Fas and Fas ligand in renal grafts with acute and chronic rejection in the rat model

The Fas system-based rejection mechanism has not been studied well in terms of cytotoxic T cell activity in graft rejection. We investigated the Fas and Fas ligand level in renal grafts with acute and chronic rejection in a rat model using semiquantitative reverse transcription-polymerase chain reaction (RT-PCR). Fas ligand in renal allografts was detected as early as 1 day after transplantation in an acute rejection model. It was highly expressed at day 4 and began to decline at day 6 after transplantation. In contrast, Fas ligand in normal kidneys was almost undetectable. Fas ligand in isografts was increased, but the expression level was much lower than in allografts. Interestingly, when Fas ligand expression began to decline in renal allografts, it increased in the spleens of recipients. Fas ligand expression in chronically rejecting allografts was slightly increased, but it was stronger than in isografts. In contrast to Fas ligand gene expression, Fas was constitutively expressed in isografts, allografts, and normal kidneys. However, the Fas level in renal allografts was higher than in normal kidneys. Our data demonstrated that the Fas system might play an important role in acute and chronic rejection by causing apoptosis, and the spleen may eliminate the lymphocytes strongly expressing Fas ligand after completion of the acute rejection.

Adequacy of pacing rate during exercise in rate responsive ventricular pacing

Our objective was to determine the adequate pacing rate during exercise in ventricular pacing by measuring exercise capacity, cardiac output, and sinus node activity. Eighteen patients with complete AV block and an implanted pacemaker underwent cardiopulmonary exercise tests under three randomized pacing rates: fixed rate pacing (VVI) at 60 beats/min and ventricular rate-responsive pacing (VVIR) programmed to attain a heart rate of about 110 beats/min or 130 beats/min (VVIR 110 and VVIR 130, respectively) at the end of exercise. Compared with VVI and VVIR 130, VVIR 110 was associated with an increased peak oxygen uptake (VVIR 110: 20.3 +/- 4.5 VVI: 16.9 +/- 3.1; P < 0.01; and VVIR 130: 19.0 +/- 4.1 mL/min per kg, respectively; P < 0.05 and a higher oxygen uptake at anaerobic threshold (15.3 +/- 2.7, 12.7 +/- 1.9; P < 0.01, and 14.6 +/- 2.6 mL/min per kg; P < 0.05). The atrial rate during exercise expressed as a percentage of the expected maximal heart rate was lower in VVIR 110 than in VVI or VVIR 130 (VVIR 110: 75.9% +/- 14.6% vs VVI: 90.6% +/- 12.8%; P < 0.01; VVIR 110 vs 130: 89.1% +/- 23.1% P < 0.05). There was no significant in cardiac output at peak exercise between VVIR 110 and VVIR 130. We conclude that a pacing rate for submaximal exercise of 110 beats/min may be preferable to that of 130 beats/min in respect to exercise capacity and sympathetic nerve activity.

Clinical evaluation of indomethacin-containing patches for osteoarthritis and extremity trauma

Seventy-eight patients, aged 12-87 years, with osteoarthritis or extremity trauma, attached one indomethacin patch (containing 96 mg indomethacin) to the most symptomatic site twice daily. The final overall treatment outcome was excellent in 52% of the osteoarthritic patients and in 82% of the trauma patients, good in 27% and 13%, and fair in 3% and 0%, respectively. Side effects were reported by 4% of the patients. It is concluded that indomethacin-containing patches were effective and well-tolerated for the treatment of osteoarthritis and extremity trauma.

Hydroxyapatite crystals in tumoral calcinosis: a case report

Calcified deposits of tumoral calcinosis from a 77-year-old Japanese woman were examined by scanning electron microscopy (SEM) and x-ray diffraction method. SEM revealed conglomerates of granular calcified materials 0.2 to 0.5 micron in size. X-ray diffraction method revealed the presence of hydroxyapatite that was highly crystallized. No other components such as calcium pyrophosphate dehydrate were detected.

[Assessment of prognostic factors in surgical treatment for the pulmonary metastasis of osteosarcoma based on results of 17 patients]

Seventeen cases with surgical treatment for pulmonary metastases of osteosarcomas have been experienced for past 20 years in our institute. Disease free intervals, tumor doubling time, the number of metastatic lesions, the size of metastatic lesions, pathological features on nuclear findings were assessed in relation to their prognosis. These parameters were concluded to have no significant relations to the survival outcomes after the surgery for pulmonary lesions except for the number of metastatic lesions less than 20 in total which is likely to be associated with long survivals, supporting previous reports on the resectability of pulmonary metastatic lesions as an only reliable prognostic indicator. It was also stressed from our experience that the meticulous follow-up after each surgery for both primary and metastatic lesions is absolutely necessary for the early detection of recurrent pulmonary lesions in order not to overlook curable cases with aggressive treatment.

Extradural granulocytic sarcoma of the thoracic spine in acute myelogenous leukemia with 8; 21 chromosome translocation

We report a case of a 19-year-old male with an extradural granulocytic sarcoma at T5/6 to T7 demonstrated by MRI. He recovered from paraplegia that had progressed rapidly after excision of the tumor as an emergency operation. Histopathological studies disclosed granulocytic sarcoma. Both peripheral blood and bone marrow examinations revealed acute myelogenous leukemia. The karyotype of the bone marrow showed 45, X, -Y, t (8; 21) (q22; q22).