Use of skin conductance changes during mental stress testing as an index of autonomic arousal in cardiovascular research

Mental stress testing is used to study the cardiovascular changes caused by psychologic stress. To examine the effects of cardiac drugs on mental stress-induced changes, it is useful to attain a degree of arousal that can be replicated in serial studies. Skin conductance level, a cholinergically mediated index of arousal, was assessed for its stability in serial studies and under conditions of beta-blockade. In normal subjects, skin conductance increased in response to mental stress (p < 0.001) and was stable across three sessions. In patients with mild hypertension, skin conductance was elevated during mental stress during both placebo and nadolol therapy (p < 0.001). As expected, nadolol reduced baseline and stress-induced peak arterial pressure and heart rate but had no significant effect on skin conductance. Thus skin conductance level can serve as a stable and useful index of autonomic arousal in clinical trials, even in patients using beta-blocking medications.

The course of psychological distress following threatened and actual conjugal bereavement

We measured multiple dimensions of distress among spouses (N = 440) of patients hospitalized for serious illness or elective surgery and compared the course of distress over 2 years of follow-up among five groups according to whether and when spouses were bereaved. Distress was related to the severity of the patient's illness, the actuality and timing of the bereavement, as well as the gender and age of the respondent.

Rare incidence of human papillomavirus types 16 and 18 in primary and metastatic human prostate cancer

OBJECTIVES

The reported data regarding the incidence and significance of human papillomavirus (HPV) in prostate cancer have been inconsistent. In the present study the incidence of HPV 16 and 18 was evaluated in an expanded series of primary as well as metastatic prostate cancer specimens, in order to evaluate a potential role of HPV infection in development and progression of prostate cancer. This is the first study attempting to establish the significance of HPV in metastatic prostate cancer.

METHODS

The presence of high risk human papillomaviruses HPV 16 and 18 was analyzed using the polymerase chain reaction (PCR) amplification method and Southern blot hybridization analysis in a total of 61 prostatic tissue specimens: 43 primary prostate adenocarcinoma formalin-fixed, paraffin-embedded specimens, with varying degrees of differentiation (mean Gleason score 5.8, range 3 to 9); 17 pelvic lymph nodes positive for metastatic deposits; and 1 normal prostate specimen.

RESULTS

This human papillomavirus typing indicates that only 1 out of the 43 prostatic specimens analyzed was positive for HPV 16 and 1 metastatic lymph node was positive for HPV 18, as revealed by Southern analysis. These results demonstrate the infrequent detection of HPV 16 and 18 DNA in all the primary prostatic adenocarcinoma specimens and metastatic lymph nodes analyzed in this study population.

CONCLUSIONS

The negative HPV status for primary and metastatic prostate cancer demonstrated in this study provides a strong argument against an etiological role of HPV infection in the development and progression of the disease.

Partial growth suppression of human prostate cancer cells by the Krev-1 suppressor gene

A series of functional studies were performed to assess the potential role of the ras-related transformation suppressor gene, Krev-1, in suppressing prostate cancer cell growth. Three human prostate cancer cell lines, PC-3, TSU-Pr1, and DU-145 were transfected with a plasmid containing the Krev-1 cDNA and a neomycin resistance gene. Selected G418-resistant clones were isolated and expanded into cell lines. All cloned transfectants exhibited a significant reduction in their in vitro growth rates, i.e., longer doubling times, when compared to the parental cell lines. Molecular analysis of the Krev-1 cloned transfectants revealed that they all contained variable copy numbers of the Krev-1 gene and expressed high levels of Krev-1 mRNA transcript, as shown by Southern and Northern analysis, respectively. To determine whether the biological properties associated with tumorigenicity were changed in these Krev-1 transfectants, their growth characteristics were examined on the basis of their ability to a) form colonies in soft agar, and b) produce tumors in SCID mice. The majority of the Krev-1 transfectants from the PC-3 and TSU-Pr1 cell lines showed a substantially reduced ability to form colonies in soft agar and produced significantly smaller tumors when inoculated into SCID mice. In contrast, there was no significant reduction in the soft agar colony-forming ability or in vivo tumorigenicity of the DU-145 Krev-1 transfectants. These results suggest that the Krev-1 suppressor gene induces partial suppression of the malignant phenotype of human prostate cancer cells containing activated ras oncogenes.

Protection elicited by a replication-defective adenovirus vector expressing the tick-borne encephalitis virus non-structural glycoprotein NS1

Tick-borne encephalitis virus (TBEV) encodes a conserved, immunogenic, non-structural protein NS1 that is glycosylated and secreted from infected cells in an oligomeric form. An adenovirus recombinant, RAd51, expressing high levels of TBEV NS1 has previously been demonstrated to protect mice against a lethal challenge with TBEV. We show here that BALB/c mice infected with TBEV experienced a transient viraemia between days 3 to 5 post-inoculation that was detectable prior to the encephalitic phase of infection. Mice vaccinated with RAd51 were protected against both the viraemic and encephalitic infections associated with the TBEV challenge. Protection was demonstrated to be due to NS1 synthesized de novo from RAd51 in the vaccinated mice. Since TBEV NS1 is expressed on the cell surface, antibody-dependent complement-mediated cytolysis (CMC) of infected cells was considered as a possible mechanism of protection. Vaccination with the recombinant adenovirus proved to be effective in a mouse strain carrying a genetic deletion in the complement receptor C5. CMC is therefore not an essential component of the observed protective immune response.

Complications after laparoscopic pelvic lymphadenectomy: CT diagnosis

OBJECTIVE

Laparoscopic dissection of pelvic lymph nodes has become an accepted alternative to open lymphadenectomy for staging of genitourinary tumors. This study reviews the CT findings in patients with major complications detected after laparoscopic dissection.

MATERIALS AND METHODS

Of 85 patients who had laparoscopic dissection of pelvic lymph nodes at our institutions during a 3-year period, complications developed in 12 patients (14%), and eight of these had abdominopelvic CT studies done. CT findings and initial interpretations were correlated with follow-up surgical, clinical, or interventional radiologic findings in all cases.

RESULTS

Complications of laparoscopic dissection detected with CT included small-bowel obstruction due to herniation through the trocar site in the abdominal wall (n = 2), extensive hematoma of the abdominal wall or retroperitoneum (n = 2), urinary ascites or multiple urinomas due to ureteral laceration or transection (n = 2), and lymphocele compressing the bladder where the peritoneum was sealed after lymphadenectomy (n = 1). In one case, CT showed pneumoperitoneum but failed to show a perforation of the sigmoid colon.

CONCLUSION

Major complications occurred after laparoscopic dissection of pelvic lymph nodes and were diagnosed on the basis of CT findings in seven of eight patients. Recognition of the CT appearances of hernia or hematoma at the insertion sites of the trocars or the laparoscope is important, as is detection of injury to bladder, ureter, bowel, or blood vessels. Symptomatic lymphoceles were infrequently detected, probably because of the use of free drainage into the peritoneal cavity after laparoscopic dissection.

Induction of apoptosis in androgen-independent human prostate cancer cells undergoing thymineless death

Previous studies have demonstrated that androgen responsive human prostate cancer cells can be induced to undergo programmed cell death after androgen ablation. By contrast, androgen-independent human prostate cancer cells do not activate this apoptotic pathway in response to androgen ablation. In the present study, two androgen-independent human prostatic cell lines, PC-3 and DU-145, were used as in vitro model systems to investigate the possibility of induction of programmed cell death in response to non-androgen ablative cytotoxic drugs. Treatment of these cells with the fluorinated pyrimidines, 5-fluoro-2-deoxyuridine or trifluorothymidine, resulted in a significant decrease in cell viability, over a period of 96 hr of exposure to the drugs, as determined by the trypan blue exclusion assay. The characteristic DNA fragmentation into a nucleosomal ladder and induction of expression of specific apoptosis-related genes, such as TRPM-2/SGP-2, and TGF-beta 1, but not the growth-related genes, c-myc, c-fos, and p53, temporally correlated with activation of apoptotic cell death in both systems. Simultaneous treatment with exogenous thymidine completely abrogated the fluoropyrimidine-induced cytotoxic effect in both cell lines, as well as the nucleosomal fragmentation of DNA, indicating that this apoptotic process is due to the induction of "thymineless" state. These results suggest that androgen-independent human prostate cancer cells retain the ability to activate the apoptotic cascade, after treatment with cytotoxic drugs that induce a "thymineless" state.

Prostatic ultrasound in the patient without a rectum

Digital rectal examination, measurement of prostatic-specific antigen, and transrectal ultrasound, with or without prostate biopsy, are the urologist's primary tools for diagnosing carcinoma of the prostate. However, in the patient who has previously undergone abdominoperineal resection of the rectum such procedures are not possible. We therefore describe a simple, cost-effective method for evaluating the prostate in the patient without a rectum, via transperineal ultrasound and prostate biopsy. This procedure provides the urologist with a solution to a heretofore difficult problem.

Combined antitumor effect of suramin plus irradiation in human prostate cancer cells: the role of apoptosis

Suramin has recently surfaced as a potential antineoplastic agent on the basis of its ability to exert a cytostatic effect on human prostate carcinoma cells. Radiotherapy for the treatment of prostate cancer has long been known as an alternative medical therapeutic approach, but the molecular mechanism involved in radiation-induced toxicity in prostatic tumors is poorly defined. In these studies, the antitumor effect of suramin and irradiation, either as individual treatments or in combination, was investigated in human prostate cancer cells. Two androgen-independent prostate cancer cell lines, DU-145 and PC-3, were used as in vitro model systems to study the underlying molecular mechanisms of these two therapeutic modalities. A cytostatic effect on cell growth was observed when cells were exposed to suramin alone, while treatment with irradiation alone resulted in significant cell death as determined by the Trypan blue exclusion assay. Suramin treatment prior to irradiation inhibited this radiation-induced cell death. In contrast, exposure of cells to suramin following irradiation enhanced the cytotoxic effect of ionizing radiation. Temporal analysis of the molecular events involved in radiation-induced toxicity revealed the characteristic fragmentation of DNA into a nucleosomal ladder (a hallmark of apoptosis) and enhanced expression of specific programmed cell death-associated genes (TRPM-2 and TGF-beta), preceding the dramatic decrease in cell number. These results indicate that radiation-induced cell death proceeds via the apoptotic pathway. Further studies have demonstrated that activation of programmed cell death by ionizing radiation is substantially inhibited by pretreatment of the cells with suramin. This study suggests that the relative timing of this combination treatment may have significant therapeutic implications in the treatment of advanced prostate cancer.

Small bowel obstruction following laparoscopic lymphadenectomy

We report 2 cases of small bowel obstruction following staging laparoscopic pelvic lymph node dissection for prostate adenocarcinoma. Short segments of ileum became incarcerated in the right lower abdominal trocar sites (10 mm.) in both patients. Laparotomy was done to repair the problem in both cases and in 1 small bowel resection was required because of strangulation. This complication can probably be prevented in the majority of cases by meticulous attention to trocar site closure at the termination of a laparoscopic procedure.

Homozygous deletion and frequent allelic loss of chromosome 8p22 loci in human prostate cancer

Allelic loss studies have been instrumental in identifying tumor suppressor gene loci in a variety of cancers. In this study we analyzed prostate cancer specimens from 52 patients for allelic loss using 8 polymorphic probes for the short arm of chromosome 8. Overall, 32 of 51 (63%) informative tumors showed loss of at least one locus on chromosome 8p. The most frequently deleted region is observed at chromosome 8p22-8p21.2. Loss of one allele is identified in 14 of 23 (61%) tumors at D8S163, in 15 of 32 (47%) tumors at lipoprotein lipase, and in 20 of 29 (69%) tumors at MSR, all on 8p22. Loss of one allele is identified in 16 of 27 (59%) tumors at D8S220 at 8p21.3-8p21.2. In addition to frequent loss of one allele at the MSR locus, one metastatic prostate cancer sample demonstrated homozygous deletion of MSR sequences. Loci telomeric and centromeric to this region are largely retained. A chromosome 8p deletion map is constructed and defines the smallest region of overlap to a 14-cM interval at 8p22 between D8S163 and lipoprotein lipase, flanking the MSR locus. Evidence of chromosome 8q multiplication at locus D8S39 was detected in 5 of 32 (16%) tumors, all of which demonstrated loss with at least one probe on chromosome 8p. This study extends the previous finding of frequent loss of chromosome 8p in prostate cancer by defining a common region of loss of heterozygosity at 8p22 and a homozygous deletion of the MSR locus contained within this region. This is the first homozygous deletion identified in the genome of a human prostate cancer and the highest rate of loss yet reported on chromosome 8p in cancer. These results strongly suggest the presence of a tumor suppressor gene in this region which is frequently inactivated in prostate cancer.

Seizures associated with antidepressants: a review

BACKGROUND

Seizures are uncommon, but serious, adverse effects of antidepressant drugs. A better understanding of drug-related seizure risk, its predictors, and its neurophysiologic basis might help clinicians avoid this adverse event. A better understanding of the factors involved in the determination of seizure risk would be helpful for interpretation of seizure rates reported.

METHOD

The authors review case reports, series of cases, and information from clinical trials of antidepressants to determine antidepressant-related seizure risk. Predisposing factors are identified. Effects of dose, blood levels, and duration of treatment on seizure risk are examined. Electrophysiologic and in vitro models of drug-related seizure induction are discussed.

RESULTS

A significant proportion of drug-related seizures occurs in individuals with an identifiable predisposition, such as previous seizures, sedative or alcohol withdrawal, and multiple concomitant medications. Seizure risk for most antidepressants increases with dose (or blood level), and comparisons between drugs should consider seizure rates at the effective dose (or blood level) for each drug. For imipramine, the most frequently studied tricyclic, the literature indicates a seizure rate between 0.3% and 0.6% at effective doses. In unselected patients and at higher doses, these rates may be higher. Fluoxetine, sertraline, fluvoxamine, trazodone, nomifensine, and the monoamine oxidase inhibitors have a lower seizure risk. Estimates for recently marketed antidepressants with intermediate seizure risk are complicated by the fact that effective doses and blood levels are not well established.

CONCLUSION

Assessment of seizure risk in individuals involves consideration of predisposing factors, the antidepressant selected, and the bioavailability of the drug. Future studies of seizure risk would benefit from the use of specified criteria for determination of probable seizure events, a priori definition of predisposing exclusions, samples sufficiently large to provide adequate power, blood level monitoring, and inclusion of duration of drug treatment in the calculation of risk.

Complications of staging laparoscopic pelvic lymphadenectomy

Fifty-four patients underwent staging laparoscopic pelvic lymphadenectomy under general anesthesia for prostatic carcinoma (49), bladder carcinoma (3), penile carcinoma (1), and lymphoma (1). Conversion to an open procedure occurred only once in the series, but three patients received secondary open operations (5.5%). Complications recognized intraoperatively included bladder perforation (2) and mesenteric hematoma (1). One bladder perforation was repaired laparoscopically. The other was treated with catheter drainage. The mesenteric hematoma was explored surgically and found to be minor. Major postoperative complications included bleeding (4) requiring transfusion in two patients. One hematoma became infected requiring percutaneous drainage. One patient required intubation due to chronic obstructive pulmonary disease (COPD). Ureteral injury (1) was recognized late and required a psoas hitch and ureteroneocystostomy. Two patients developed small bowel obstructions due to herniation through a trocar site, requiring operative correction. Minor postoperative complications included ileus (4), diarrhea (2), bronchospasm (1), transient obturator nerve palsy (1), electrocardiogram changes (1), and fever (1). The overall major complication rate was 16.7%, and the overall minor complication rate was 18.4%. In this series, a substantial learning curve was seen with regard to complications, but the series compared favorably with open lymphadenectomy.

Hyperbaric oxygen treatment for experimental cyclophosphamide-induced hemorrhagic cystitis

Acrolein is a toxic metabolite of cyclophosphamide that causes hemorrhagic cystitis in 2 to 40% of treated patients. Hyperbaric oxygen (HBO) is used to treat poorly healing wounds in conditions such as Fournier's gangrene and radiation-induced cystitis. The present study was designed to evaluate the effects of HBO on acute acrolein-induced hemorrhagic cystitis in a rat model. Rats were divided into 4 groups. Group I served as a control and received only HBO prior to sacrifice. Group II received acrolein only, while groups III and IV received acrolein as well as HBO therapy. Hyperbaric oxygen (100% oxygen, 2.8 atmospheres, 90 minutes) was delivered twice a day for 4 days, with group III receiving a fifth HBO treatment just before acrolein and group IV receiving the fifth HBO treatment just after acrolein. After therapy, the amount of urothelial injury was determined morphometrically. Group II untreated rat bladders had only 33% of the urothelium intact after acrolein injury, whereas groups III and IV rat bladders had 93% (p < 0.01) and 55% (p < 0.01) intact urothelium, respectively, after treatment with HBO. The timing of the HBO treatment appeared to be a critical factor, with less injury occurring if the fifth HBO treatment immediately preceded acrolein. These results suggest that HBO may be useful as prophylaxis and treatment of cyclophosphamide-induced hemorrhagic cystitis.

Late invasive recurrence despite long-term surveillance for superficial bladder cancer

Superficial transitional cell carcinoma of the bladder is associated with a 15 to 70% recurrence rate within 2 years. Most recurrences are superficial. A recurrence after 2 disease-free years is unusual. A review of the tumor registry revealed 124 patients followed for superficial disease at the Veterans Administration Center in Baltimore. Of the patients 20 were identified with either stage Ta (7) or stage T1 (13) papillary transitional cell carcinoma who had completed at least 5 years of surveillance without tumor recurrence. Invasive transitional cell carcinoma of the bladder requiring cystectomy developed in 7 of these 20 patients after remaining tumor-free for 5 years (stage Ta in 4 and stage T1 in 3). All 7 patients had organ-confined disease and were alive with no evidence of disease at 18 months to 5 years after cystectomy. These results demonstrate that superficial, low grade transitional cell carcinoma of the bladder can become muscle invasive despite careful surveillance and a long dormant period. In our series yearly cystoscopy and urine cytology identified tumor recurrence before metastases developed, suggesting that long-term surveillance is required in patients with superficial bladder cancer.

Suramin, an active drug for prostate cancer: interim observations in a phase I trial

BACKGROUND

Previous studies indicate that suramin may be an active agent for treatment of solid tumors. The clinical use of suramin is complicated by a broad spectrum of toxic effects and complex pharmacology. Studies have suggested that the dose-limiting neurotoxicity of this agent is closely related to sustained plasma drug concentrations of 350 micrograms/mL or more.

PURPOSE

This phase I clinical trial in patients with solid tumors was designed to determine whether plasma concentrations resulting in both antitumor activity and manageable toxicity could be achieved with short, intermittent infusions of suramin.

METHODS

Thirty-seven patients, including 33 with metastatic, hormone-refractory prostate cancer, collectively received 43 courses of suramin designed to maintain a plasma concentration range of 200-300, 175-275, or 150-250 micrograms/mL. Patients received a test dose of 200 mg and an initial loading dose of 1000 mg/m2 on day 1 of therapy. Subsequent suramin doses and schedules were individually determined using a strategy of adaptive control with feedback, which used a maximum a posteriori Bayesian algorithm to estimate individual pharmacokinetic parameters. Patients were treated until dose-limiting toxicity or progressive disease developed.

RESULTS

Thirty-five of the 37 study patients and 31 of the 33 with prostate cancer were assessable for toxicity and response. Treatment was discontinued in 28 patients because of dose-limiting toxicity consisting of a syndrome of malaise, fatigue, and lethargy; recurrent reduction in creatinine clearance of 50% or more; or axonal neuropathy. Evidence of major antitumor activity was observed in patients with prostate cancer treated at all three plasma drug concentrations. Measurable responses (one complete response and five partial responses) were noted in six of 12 patients with measurable disease. Twenty-four (77%) of 31 patients had a reduction in prostate-specific antigen of 50% or more, and 17 (55%) of 31 had a reduction of 75% or more. Twenty (83%) of 24 patients reported reduction in pain.

CONCLUSIONS

Suramin can be safely administered as an intermittent bolus injection by use of adaptive control with feedback to control plasma drug concentrations; toxicity is significant but manageable and reversible. Suramin is active against hormone-refractory prostate cancer.

IMPLICATIONS

Future trials should address the role and necessary extent of therapeutic drug monitoring; the optimal plasma drug concentration range and duration of therapy; and the activity of suramin in combination with other agents, in earlier stages of prostate cancer, and in other tumor types.

Sequence of the NS 1 gene of the K 23 isolate of tick-borne encephalitis virus and identification of conserved motifs

The NS 1 gene from the K 23 isolate of tick-borne encephalitis virus has been sequenced. The NS 1 gene sequence, and many structural features of the NS 1 protein are heavily conserved. Six conserved peptides were also identified.

Effects of annular cranial vault modification on the cranial base and face

Artificial modification of the cranial vault was practiced by a number of prehistoric and protohistoric populations, frequently during an infant's first year of life. We test the hypothesis that, in addition to its direct effects on the cranial vault, annular cranial vault modification has a significant indirect effect on cranial base and facial morphology. Two skeletal series from the Pacific Northwest Coast, which include both nonmodified and modified crania, were used: the Kwakiutl (62 nonmodified, 45 modified) and Nootka (28 nonmodified, 20 modified). Three-dimensional coordinates of 53 landmarks were obtained using a diagraph, and 36 landmarks were used to define nine finite elements in the cranial vault, cranial base, and face. Finite element scaling was used to compare average nonmodified and average modified crania, and the significance of the results were evaluated using a bootstrap test. Annular modification of the cranial vault produces significant effects on the morphology of the cranial base and face. Annular modification in the Kwakiutl resulted in restrictions of the cranial vault in the medial-lateral and superior-inferior dimensions and an increase in anterior-posterior growth. Similar dimensional changes are observed in the cranial base. The Kwakiutl face is increased anterior-posteriorly and reduced anterior-laterally to posterior-medially. Similar effects of modification are observed in the Nootka cranial vault and cranial base, though not in the face. These results demonstrate the developmental interdependence of the cranial vault, cranial base, and face.

Cryptococcal prostatic abscess associated with the acquired immunodeficiency syndrome

A case of cryptococcal prostatic abscess in a 28-year old man with the acquired immunodeficiency syndrome is presented. This is a unique presentation of a cryptococcal prostatic infection and of a prostatic abscess. The diagnosis and management are discussed, and the literature is reviewed.

Ureteral injury due to blunt and penetrating trauma

In a period of twenty-seven months, 15 patients with ureteral trauma were encountered, leading us to believe that there is an increasing incidence of these injuries. The injuries were caused by blunt trauma in 3 patients and gunshot wounds in 12. All patients sustained injuries to other organs as well as the ureter. The diagnosis of ureteral injury was frequently delayed beyond the day of presentation (33%) primarily due to the number and severity of associated injuries. The most accurate methods of diagnosis were surgical exploration and retrograde pyelography. Intravenous pyelography and abdominal computerized tomography scanning were diagnostic in only 33 percent of cases. Hematuria was present in only 63 percent of patients who had no other genitourinary injuries, emphasizing the lack of reliability of this sign in ureteral trauma.

Tocopherol analogs suppress arachidonic acid metabolism via phospholipase inhibition

alpha-Tocopherol and three derivatives in which the phytol chain is modified or deleted were examined for their effect on cultured keratinocyte arachidonic acid metabolism. 2,2,5,7,8-Pentamethyl-6-hydroxychromane (PMC), in which the phytol chain is replaced by a methyl group, inhibited basal, bradykinin (BK)- and A23187-stimulated prostaglandin E2 (PGE2) synthesis with an apparent Ki of 1.3 microM. The Ki of the analogue with six carbon atoms in the side chain (C6) was 5 microM while that of the C11 analogue was 10 microM. No effect of alpha-tocopherol was observed. The mechanism of inhibition was studied using PMC. The effect of PMC on phospholipase and cyclooxygenase activity was assayed using stable isotope mass measurements of PGE2 formation, which assesses arachidonate release and cyclooxygenase metabolism simultaneously. BK-stimulated formation of PGE2, derived from endogenous phospholipid, was decreased 60% by 5 microM PMC and eliminated by 50 microM PMC, compared with controls. No difference in PGE2 formed from exogenous arachidonic acid was observed, indicating no effect of PMC on cyclooxygenase activity. In contrast, no effect of 5 microM PMC was observed on BK-stimulated [3H]arachidonic acid release from prelabeled cultures. The capacity of PMC to inhibit phospholipase activity in vitro was also assessed. PMC inhibited hydrolysis of phospholipid substrate by up to 60%. These results suggest that alpha-tocopherol analogues with alterations in the phytol chain inhibit eicosanoid synthesis by preferential inhibition of phospholipase.

Late development of renal carcinoma in allograft kidney

The Cincinnati Transplant Tumor Registry recorded 169 cases of renal carcinoma developing in transplant recipients. The great majority of these cases were of primary renal cell carcinoma developing in the recipient native kidneys. Renal carcinoma developing de novo in the renal allograft occurred 17 times, with a maximal interval to clinical development of 85 months after transplantation. The development of multicentric renal cell carcinoma in an allograft 156 months after transplantation is described. The 24-year-old white male recipient with Alport's syndrome received a cadaver renal allograft from a healthy 27-year-old black man who had died of a cerebral hemorrhage in 1977. At 13 years after transplantation the recipient had upper abdominal pain. Ultrasound revealed 2 incidental renal masses and a renal cyst in the allograft. Partial nephrectomy confirmed the presence of multicentric renal carcinoma. The graft was left in situ and immunosuppression was maintained. The recipient continued to do well with no evidence of disease 1 year postoperatively. Deoxyribonucleic acid banding demonstrated that the tumor and recipient blood were of different patterns.