Telomerase activity in adrenal cortical tumors and pheochromocytomas with reference to clinicopathologic features

Telomeres consist of short repeated sequences that are shortened on continuous cell proliferations and synthesized by telomerase, an RNA-dependent DNA polymerase. Recent molecular studies have reported that telomerase is activated in most human cancers, whereas it is not detected in most somatic cells. These findings indicate that the positive telomerase activity is closely related to the malignant potential of human tumors. In several types of human tumors, including adrenal cortical tumors and pheochromocytomas, it is very difficult to predict the malignant potential using conventional histopathologic examination. To determine whether telomerase activity is useful as a diagnostic marker, we examined telomerase activity in adrenal cortical tumors and pheochromocytomas with special reference to their clinicopathologic features. Using a highly sensitive polymerase chain reaction (PCR)-based detection method, telomerase activity was demonstrated in one of 13 adrenal cortical tumors and two of seven pheochromocytomas, whereas all seven normal portions of adrenal gland failed to showed any telomerase activity. Although none of the tumors examined in this study was associated with metastasis, these three telomerase-positive tumors were accompanied by clinicopathologic features suggesting malignant potential. Telomerase activity might be a potential marker for estimating the biologic characteristics of adrenal cortical tumors and pheochromocytomas.

Absence of p53 overexpression and favorable response to cisplatin-based neoadjuvant chemotherapy in urothelial carcinomas

It has been controversial whether cancer cells harboring loss or inactivation of the tumor suppressor p53 are resistant or sensitive to DNA-damaging agents including cisplatin and doxorubicin. Overexpression of mdm2 oncoprotein, a negative regulator of p53, is assumed to be an alternative to p53 dysfunction. Archival urothelial carcinoma specimens obtained from 60 patients prior to cisplatin-based chemotherapy were immunohistochemically studied for overexpression of p53 and mdm2. Thirty-two patients (group I) were treated with chemotherapy in the neoadjuvant setting, while 28 patients (group II) underwent chemotherapy for distant metastases or inoperable locoregional tumors. In group I, the responsiveness was correlated with staining status of p53 (P=0.0225) and the combination of p53 and mdm2 (P=0.0497). Negative staining of p53 and negative for both p53 and mdm2 could have predicted favorable response to chemotherapy in 16 of 18 (88.9%) and in 12 of 13 (92.3%) tumors, respectively. On the other hand, p53-positive and p53 and/or mdm2-positive staining could have predicted poor response only in 7 of 14 (50.0%) and 8 of 19 (42.1%) tumors, respectively. Disease-specific survival of the p53-negative group was significantly superior to that of the p53-positive group (P=0.0086). Difference in survival did not become more significant when overexpression of mdm2 was taken into consideration (P=0.0456). In contrast, in group II, there was no correlation of responsiveness to chemotherapy or survival with p53- or p53/mdm2-staining status. The patients with urothelial carcinomas negative for overexpression of p53 will benefit from neoadjuvant chemotherapy. From clinical viewpoint, however, p53 status alone or the combination of p53 and mdm2 status is not enough to identify those patients who will not benefit from the treatment.

Prognostic factors in uterine carcinosarcoma: a clinicopathologic study of 25 patients

BACKGROUND

Carcinosarcoma (malignant mixed mullerian tumor) of the female genital tract is a highly malignant neoplasm. The tumor stage and histologic grade of the carcinomatous component are among the important prognostic indicators cited in the literature for this tumor.

METHODS

Twenty-five patients with uterine carcinosarcoma at 4 hospitals in the Kyoto and Nara areas of Japan were studied retrospectively. The clinicopathologic and immunohistochemical data including p53, bcl-2, Ki-67, and proliferating cell nuclear antigen (PCNA) staining were analyzed using univariate and multivariate analysis with the Cox proportional hazards model to investigate potential prognostic indicators for this neoplasm.

RESULTS

The 5-year survival rate was 36.4% for all stages, 62.3% for Stage I, and 0% for Stages II-IV. From the univariate analysis, stage (P = 0.0001), endometrioid adenocarcinoma as a carcinomatous component (P = 0.0006), age (P = 0.0355), and a heterologous sarcomatous component (P = 0.0421) were found to be prognostically significant for patient survival. Stage was the only independent significant factor in the multivariate analysis (t = 2.212). None of the other factors (history of pregnancy and gestation, gross appearance of the tumors, grade of the carcinomatous component, mitotic count of the sarcomatous component, Ki-67 and PCNA reactivity, or p53 or bcl-2 positive staining) was found to be a significant prognostic indicator.

CONCLUSIONS

Stage appears to be the only definite independent prognostic indicator of survival in patients with uterine carcinosarcoma. It is uncertain whether age, endometrioid adenocarcinoma as a carcinomatous component, or absence of a heterologous component in the sarcomatous area are prognostic factors. Immunohistochemical expression of p53, bcl-2, Ki-67, or PCNA is not a prognostic indicator. The immunohistochemical results of the current study may support the hypothesis of a common stem cell origin of this tumor.

Myocardial rest iodine-123-beta-methyl-iodophenyl-pentadecanoic acid scintigraphy compared with dipyridamole stress thallium-201 scintigraphy in unstable angina

Twelve patients with stable angina and 12 patients with unstable angina underwent rest iodine-123-beta-methyl-iodophenyl-pentadecanoic acid (BMIPP), dipyridamole stress thallium scintigraphy and delayed thallium scintigraphy. In stable angina, sensitivity for detecting ischemic segments was higher in dipyridamole thallium (74%) than rest BMIPP (48%) images (p<0.05), but there was no significant difference between the 2 images in unstable angina. In unstable angina, the incidence of segments with higher defect scores on BMIPP images than on delayed thallium images and the opposite pattern was 27 and 5 (p<0.01). In stable angina, there was no difference. The mean defect score on BMIPP (6.3 +/- 5.6) was higher than that on delayed thallium scintigraphy (2.9 +/- 2.7) and it was almost the same as on the initial dipyridamole stress test (6.5 +/- 5.2). In conclusion, BMIPP scintigraphy is safer and may be as useful in detecting myocardial ischemia in patients with unstable angina as thallium scintigraphy.

Refinement of the BCL2/immunoglobulin heavy chain fusion gene in t(14;18)(q32;q21) by polymerase chain reaction amplification for long targets

The t(14;18)(q32;q21) translocation, involving the BCL2 gene and junctional segments (JH) of the immunoglobulin heavy chain gene (IGH), constitutes the most common chromosomal translocation in non-Hodgkin's lymphoma of B-cell type. Although the breakpoints in BCL2 are largely clustered within the major breakpoint region (MBR) and minor cluster region (mcr), it is known that some breakpoints map away from these regions, resulting in negative amplification of the junctional sequence by polymerase chain reaction (PCR) for < 1 kb targets. To circumvent this problem, we applied a novel PCR technology for long DNA targets, long-distance (LD-) PCR, to the detection of t(14;18) in clinical materials. Oligonucleotide primers were designed to be quite distant from the two known cluster regions in BCL2, and those for the corresponding IGH were complementary to the enhancer and constant regions. In all 52 cases identified as carrying BCL2/JH fusion by conventional Southern blot analysis, LD-PCR successfully amplified fragments encompassing the junctions, which were readily identifiable on ethidium bromide-stained gel. The size of the LD-PCR products ranged from 3.9 kb to 10.7 kb in MBR/IGH fusion and 1.9 kb to 16 kb in mcr/IGH fusion. Furthermore, we established an LD-PCR protocol for > 20 kb targets, which covered the intervening region between the MBR and mcr. Restriction analysis of the LD-PCR products revealed that breakpoints in 33 cases fell within the 150 bp-MBR region, and in 3 cases were within the mcr determined previously by others. In contrast, the breakpoints of the remaining 16 cases were distributed over a large region from the MBR through mcr. Nucleotide sequence analysis of a potential cluster region revealed the presence of an Alu repeat sequence. Restriction analysis of LD-PCR products with BstEII demonstrated a predominant usage of the JH6 segment (71%) at the BCL2/JH junctions. LD-PCR using primers for the constant region genes showed that class switch recombination occurred in more than 80% of the IGH genes on the der(14) chromosome. Our study showed that LD-PCR was capable of detecting virtually any t(14;18) that occurred within the approximately 30 kb region downstream of the MBR, and thus is suitable for initial diagnosis of lymphoma tissues. Furthermore, as amplified fragments obtained by the LD-PCR contained distinctive regions of BCL2 and IGH, restriction analysis and nucleotide sequencing of the products refined the characteristics of t(14;18).

Heterogeneous distribution of K-ras-mutated epithelia in mucinous ovarian tumors with special reference to histopathology

The carcinogenic process of epithelial ovarian carcinomas is still unknown, and both pathways of de novo carcinogenesis from the surface epithelium and malignant transformation of benign cystadenoma have been suggested. Especially in mucinous ovarian tumors, the transition from benign cystadenomas to tumors of low malignant potential (LMP) or carcinomas has been implicated. To elucidate this possibility, we analyzed the presence or absence of heterogeneity of the K-ras mutation corresponding to the histological heterogeneity in 71 epithelial ovarian tumors, including 31 mucinous tumors. K-ras mutation was identified in nine mucinous tumors (4 of 10 carcinomas, 4 of 14 LMP tumors, and 1 of 7 cystadenomas) and in two nonmucinous carcinomas. Microdissection of multiple sites with reference to their histological appearance showed the heterogeneous distribution of K-ras-mutated epithelia in two of the nine mucinous tumors. One mucinous carcinoma showed K-ras mutation in all of the histologically LMP and malignant portions, but not in benign portions. In another LMP tumor, all of the LMP portions and one of the benign portions showed K-ras mutation, whereas the other two benign portions had no mutation. In the remaining seven mucinous tumors with K-ras mutation, however, there was a homogeneous distribution of K-ras-mutated epithelia irrespective of their histological appearance. These findings suggest that the K-ras mutation occurs during the transformation from benign cystadenomas to LMP or malignant lesions, providing molecular genetic support for the hypothesis of the "adenoma-carcinoma sequence" in some mucinous ovarian tumors, but in other cases an alternative pathway may also be possible.

An autopsy case of angioimmunoblastic T-cell lymphoma with a high content of epithelioid cells in the lymph node: immunohistochemical and genomic analyses

A 79-year-old female developed red papulonodular eruptions on her extremities, facial erythema, generalized lymphadenopathy and high fever. Histopathology of an affected lymph node showed the features of angioimmunoblastic T-cell lymphoma with a high content of epithelioid cells. She died about two years after the onset despite therapy. Genomic Southern blotting and immunostaining of the lymph nodes were performed twice. In August of 1993, Southern blotting did not show any rearrangement of the immunoglobulin or the T-cell receptor (TCR) gene. Small or medium-sized lymphoid cells were positive for CD4 or CD8 (CD4:CD8 = 2:1). However, in September of 1994 (at autopsy), rearrangements of TCK C beta 1, J beta 2 and J gamma genes were observed. Small or medium-sized lymphoid cells were positive for CD4, but negative for CD8. Several large cells were positive for Latent Membrane Protein 1 (LMP1) of the Epstein-Barr virus (EBV). Our results proved that selective oligoclonal proliferation of tumor cells (probably CD4+) accompanied the disease progress.

Systemic lupus erythematosus associated with transverse myelitis and parkinsonian symptoms

A 31-year old woman developed transverse myelitis after 10 years remission since she was first diagnosed as systemic lupus erythematosus. Although pulse methyl prednisolone resolved her myelitis, Parkinson-like symptoms developed subsequently after reduction of steroid. Treatments including apheresis did not improve her Parkinson-like symptoms such as rigidity, akinesia, impairment of speech and mask-like facial expression. Levodopa was effective as a symptomatic therapy. Orally administered cyclophosphamide eventually led her to remission and withdrawal from levodopa. Her clinical course and the absence of other possible causes prompted us to conclude that Parkinsonian symptoms as well as transverse myelitis may have developed as manifestations of central nervous system lupus.

Immunohistochemical expression of nm23 gene product, nucleotide diphosphate kinase, in pancreatic neoplasms

CONCLUSION

Our findings suggest that contrary to the proposed role for the nm23 protein as a tumor metastasis suppressor, in pancreatic tumors, the nm23 protein does not play an important role as a suppressor against tumor metastasis.

BACKGROUND

The nm23 gene product, nucleotide diphosphate kinase, is believed to suppress tumor metastasis. Although a number of studies on many kinds of tumors have examined the relationship between nm23 expression and metastatic potential, the antimetastatic activity of nm23 remains controversial. The expression of the nm23 protein has not been examined in pancreatic tumors, except for a few reports on pancreatic duct cell carcinomas.

METHODS

We have investigated nm23 expression in pancreatic duct cell carcinomas, islet cell tumors, and ampullary carcinomas by immunohistochemical methods.

RESULTS

In 73 cases of pancreatic duct cell carcinomas, the nm23 expression was increased when compared with the adjacent normal pancreatic ducts; diffuse immunostaining was detected in 21 (29%) cases, focally positive immunostaining in 47 (64%) cases, and negative immunostaining in 5 cases (7%). All five negative samples were obtained from distant metastatic regions. However, there was no significant difference in the nm23 expression between primary tumors and regional lymph node metastases. Furthermore, there was no significant correlation between nm23 expression and the prognosis of the 55 resected cases. In the 15 cases of ampullary carcinomas, all 15 tumors were positive for nm23 protein (6 diffuse and 9 focal), and the staining intensity was stronger than in normal pancreatic ducts. There was no significant difference in the nm23 expression in the primary regions between patients with and without lymph node metastasis (2 diffuse and 5 focal out of 7 patients with lymph node metastasis, and 4 diffuse and 4 focal out of 8 patients without lymph node metastasis). All 12 islet cell tumors showed strong and diffuse staining for the nm23 protein.

Production of monocyte chemoattractant protein-1 by cultured glomerular epithelial cells: inhibition by dexamethasone

Glomerular epithelial cells (GECs) have been shown to be one class of target cells in immunological and nonimmunological glomerular injury of glomerulonephritis, some cases of which are accompanied by infiltration of glomeruli by monocytes/macrophages. In this study we tested whether GECs in culture produce monocyte chemoattractant protein-1 (MCP-1), a potential molecule responsible for monocyte recruitment in inflammation, and whether the production is inhibited by glucocorticoid. GECs were obtained from outgrowth of rat glomeruli. Levels of MCP-1 mRNA and protein were determined by Northern blot analysis and ELISA, respectively. Northern blot analysis revealed the expression of MCP-1 mRNA in cytokine-treated GECs. The expression of MCP-1 mRNA was inhibited by dexamethasone. Quantitative analysis by ELISA confirmed the production of MCP-1 protein by GECs and the inhibitory effect of dexamethasone. These results indicate that cytokine-treated GECs produce and secrete MCP-1 and that the MCP-1 production is inhibited by dexamethasone. We suggest that MCP-1 produced by GECs may play a role in the recruitment of monocytes/macrophages in glomerulonephritis and that the therapeutic effect glucocorticoid on the disease might include the inhibition of the production of MCP-1.

Clinical application of cardiac output during ramp exercise calculated using the Fick equation--comparison with the 2-stage bicycle ergometer exercise protocol in the supine position

The purpose of this study was to clarify whether the direct Fick method is applicable to the measurement of cardiac output (Q) during ramp exercise. Twelve patients with chronic health failure underwent both a ramp exercise test and a steady-state exercise test. Oxygen intake (VO2), arterial oxygen saturation and mixed venous oxygen saturation were continuously measured using a pulse oximeter and a fiberoptic catheter, and the arteriovenous oxygen difference (a-v O2 diff) and Q were calculated. Both VO2 and a-v O2 diff were significantly lower in the ramp protocol than in the steady-state protocol when they were compared at the same workload. However, the VO2 vs Q relationship and the VO2 vs a-v O2 diff relationship were very similar in the 2 protocols. The difference between Q measured during steady-state exercise and Q calculated at the matched VO2 during ramp exercise was small (3.7 +/- 7.0% and 5.6 +/- 6.6%). The results indicate that, clinically, Q measured by the direct Fick method with simultaneous measurement of VO2 and a-v O2 diff during ramp exercise is a good substitute for the true Q measured by the steady-state protocol. We conclude that Fick Q is applicable to ramp exercise.

Early detection of left atrial thrombus in acute cardiogenic cerebral embolism by transesophageal echocardiography

Re-embolization tends to occur during the first 14 days after the onset of cardiogenic cerebral embolism. The usefulness of early transesophageal echocardiography (TEE) was investigated in 64 patients (33 men and 31 women, mean [+/-SD] age 70.1 +/- 12.6 years) who underwent TEE within 30 days of the onset of cardiogenic cerebral embolism. Patients were retrospectively classified into two groups based on the time from the onset of the embolism to performance of TEE: group A consisted of 33 who underwent TEE within 4 days of the onset and group B consisted of 31 who underwent TEE 5 to 30 days after the onset. Transthoracic echocardiography visualized a left atrial thrombus in two patients, and TEE detected thrombi in 14 patients: 11 in group A and 3 in group B. Lethal re-embolization occurred in two patients in group A who had highly mobile thrombi. Early TEE may be useful for detecting left atrial thrombi and predicting the risk of re-embolization in patients with acute cardiogenic cerebral embolism.

[Renal lesions of rats induced by antibodies to cultured rat glomerular epithelial cells and mesangial cells]

Renal lesions of rats induced by antibodies to cultured rat glomerular epithelial cells (GEC) and mesangial cells (GMC) were studied. Antibodies to cultured rat GEC and GMC were produced by immunization of rabbits with GEC and GMC respectively. The rats injected with anti-GEC antibody showed a small amount of urinary protein, glomerular deposition of rabbit IgG and subepithelial dense deposits observed by electron microscopy. Proteinuria was suppressed in the rats in which complement was depleted with cobra venom factor. Western blot analysis demonstrated a band of 200 KD in GEC lysates reacted with anti-GEC antibody. The rats injected with anti-GMC antibody showed little urinary protein, glomerular deposition of rabbit IgG and mesangial dense deposits. Western blot analysis demonstrated two bands of 43 and 14 KD in GMC lysates reacted with anti-GMC antibody. These data showed that the injection of anti-GEC antibody or anti-GMC antibody induced similar lesions to passive Heymann nephritis and anti Thy 1.1 nephritis. This study suggested that antigenicity of structural glomerular cells is important as the antigens of glomerulonephritis.

Dependence of peak oxygen uptake on oxygen transport capacity in chronic heart failure: comparison of graded protocol and fixed protocol

Oxygen transport capacity is the most important determinant of maximum oxygen uptake (V(O2) max) in healthy subjects, however, its role is controversial in patients with chronic heart failure (CHF). The aim of this study was to clarify whether the oxygen transport capacity is an actual determinant of exercise capacity in CHF patients. Thirteen CHF patients underwent two maximum exercise tests, i.e., a graded protocol test and a fixed protocol test, measuring expiratory gases, leg blood flow (LBF), and arterial and venous blood gases. The workload of the fixed protocol was set to exceed the peak workload obtained by the graded protocol. Exercise with the fixed protocol caused significantly larger peak V(O2) compared to the graded protocol (813+/-194 to 971+/-203 ml/min, P<0.001). Peak LBF increased by 17%, while the peak leg arterio-venous oxygen difference increased by 5% from the graded protocol to the fixed protocol. The linear correlation between leg venous partial oxygen pressure and peak V(O2) was more clearly manifested in the fixed protocol (r=0.60, P<0.05) than in the graded protocol (r=0.47, NS). In conclusion, the exercise with graded protocol did not always conduct the upper limit of oxygen demand/supply relationship in CHF patients, whereas, the fixed protocol with a larger workload produced larger peak V(O2) and manifested the mechanism to limit V(O2) by oxygen transport capacity.

Coexistence of a graft with the preserved native liver in auxiliary partial orthotopic liver transplantation from a living donor for ornithine transcarbamylase deficiency

BACKGROUND

Auxiliary partial orthotopic liver transplantation (APOLT) has recently been performed in patients with noncirrhotic metabolic liver diseases. However, long-term outcomes for the preserved native liver and the transplanted liver graft have not been clearly established yet.

METHODS

The recipient was a 36-month-old girl with ornithine transcarbamylase deficiency. She underwent APOLT, using her father's left lateral segment.

RESULTS

Liver function was normalized soon after APOLT and the patient was able to ingest a normal diet without medication. Coexistence of the well-functioning native liver and graft was demonstrated in a computed tomography scan, Doppler ultrasonography, scintigraphy, and histological examination, during a relatively long-term follow-up period.

CONCLUSIONS

APOLT seems to be most useful for the treatment of noncirrhotic metabolic liver diseases.

p53 mutation and protein overexpression in the early stages of esophageal tumorigenesis utilizing endoscopically obtained biopsy specimens

It is unclear whether p53 abnormality in the early esophageal tumorigenesis causes clonal expansion with tumor growth. In this study, we analyzed p53 abnormalities by PCR-SSCP and immunohistochemistry in 86 esophageal endoscopic biopsy specimens. Eleven of 27 specimens (39%) of mild dysplasias showed p53 mutations. Six moderate or mild dysplasias were followed by endoscopy (average 73 weeks) and continually exhibited the same p53 mutation, but none of them showed apparent tumor growth and subepithelial epithelial invasion. These results suggest that p53 mutations occur very early in the esophageal tumorigenesis and contribute to cell proliferation, but cannot be related with malignant phenotype directly.

Prognostic criteria in patients with prostate cancer: Gleason score versus volume-weighted mean nuclear volume

Gleason's score (GS) has been reported to be the most valuable prognostic factor in cases of prostate cancer. GS is solely dependent on the histological architecture of the prostate cancer, but, it seems doubtful that histological patterns are sufficient for evaluating the degree of malignancy of prostate cancer. We previously reported that the estimation of volume-weighted mean nuclear volume (MNV) might be a more useful prognosticator for prostate cancer than subjective histological grading. However, the previous study was conducted on patients treated in a single hospital, and the number of subjects was too small to draw a definitive conclusion. In this study, we analyzed a larger number of subjects at another institution using a blinded study design. A retrospective prognostic study of 195 patients with prostate cancer diagnosed between January 1966 and December 1988 at Kyoto University Hospital, and treated by conservative therapy, was conducted. Unbiased estimates of MNV were compared with the clinical stage and histological grading according to GS with regard to the prognostic value. Univariate analysis revealed that estimates of MNV, clinical stage, and GS all correlated significantly with disease-specific survival in cases of prostate cancer. Multivariate analysis of all cases also revealed that all of these factors were significant independent prognosticators of disease-specific survival. However, focusing on clinically localized cases (stages A, B, and C), multivariate analysis revealed that the estimation of MNV was the only powerful prognosticator of prostate cancer. This study indicates that the estimation of MNV is prognostically equal or superior to GS in cases of prostate cancer. We emphasized that the estimates of MNV is a more objective method for histological grading to predict the malignant potential of prostate cancer.

Thrombin stimulates production of transforming growth factor-beta by cultured human mesangial cells

Fibrin formation within the glomeruli occurs in various forms of human and experimental glomerulonephritis and it may play an important role in progressive glomerular injury. Transforming growth factor-beta (TGF-beta) has been shown to participate in the glomerular accumulation of extracellular matrix in glomerulonephritis. We investigated whether thrombin, an important coagulation factor, could modulate the production of TGF-beta by cultured human mesangial cells (HMC). TGF-beta levels in the culture supernatants were measured by ELISA using a specific antibody. The TGF-beta concentration was significantly increased by incubation of HMC with thrombin in a time-dependent manner. The stimulating effect of thrombin on TGF-beta was inhibited by addition of hirudin (a natural thrombin inhibitor) and argatroban (a synthetic thrombin inhibitor). In addition DFP-inactivated thrombin, which has no enzymatic activity, did not stimulate TGF-beta production. A protein kinase C inhibitor (H7) and a tyrosine kinase inhibitor (herbimycin A) also inhibited thrombin induced TGF-beta production. These findings suggested that thrombin may modulate the synthesis of TGF-beta via protein kinase C- and tyrosine kinase-dependent mechanisms in cultured HMC. Thus thrombin may participate in the accumulation of extracellular matrix in glomeruli through the augmentation of TGF-beta production.

Impaired coronary circulation in acute myocardial infarction: a dipyridamole-thallium-201 study

Coronary flow reserve is not fully restored immediately after revascularization of an occluded vessel. The present study examined the coronary flow impairment in patients with acute myocardial infarction (AMI) after successful balloon angioplasty or spontaneous recanalization (without residual epicardial coronary stenosis). Fourteen patients underwent thallium-201 dipyridamole scintigraphy in the acute phase (mean 5.9 days) and in the chronic phase (mean 24. 6 days) after AMI. A 201Tl reinjection study was carried out only in the acute phase of AMI. The fill-in phenomenon was assessed by the %201Tl uptake in the infarct region after 201Tl reinjection, and positive (n=8) and negative (n=6) fill-in groups were distinguished. The %201Tl uptake increased from the acute phase study to the chronic phase study in the positive fill-in group (56.1%+/-4.1% to 74.4%+/-13.6%, P<0.001), whereas it decreased in the negative fill-in group (54.0%+/-10.6% to 43.7%+/-9.9%, P<0.05). The change in %201Tl uptake following reinjection was significantly correlated with the improvement in regional ventricular wall motion in the chronic phase (r=0.85, P<0.001). We conclude that the impaired coronary flow reserve persisted after balloon angioplasty or spontaneous recanalization, which might indicate the presence of "microvascular stunning". The increase in %201Tl uptake predicted the change in ventricular wall motion.

Acute left ventricular dysfunction and left ventricular thrombus in a patient with cerebral hemorrhage

A 66-year-old woman was admitted to the hospital with a cerebral hemorrhage. An echocardiogram showed severe left ventricular hypokinesis and a left ventricular thrombus. An electrocardiogram showed ST segment elevation in the precordial leads. The patient's creatine kinase level was elevated. A follow-up echocardiogram performed 1 month after admission showed normalization of left ventricular wall motion and disappearance of the thrombus. The results of thallium myocardial scintigraphy, coronary arteriography, and left ventriculography performed 1 month after admission were normal, and the patient was discharged without clinical sequelae. The cause of the patient's left ventricular dysfunction was believed to be not myocardial infarction or myocarditis, but a massive adrenergic discharge due to the cerebral hemorrhage.

Primary testicular non-Hodgkin's lymphoma: a clinical study and review of the literature

Non-Hodgkin's lymphoma (NHL) of the testis is a rare disease, and treatment outcome is generally poor. In this retrospective study, we investigated treatment results for testicular NHL in an attempt to develop an effective treatment policy for this disease. The survival rate and characteristics were retrospectively analyzed in eight patients with NHL of the testis who were treated between 1969 and 1991 at Kyoto University Hospital, Department of Radiology. Four patients were at stage IEA, one at stage IIEA, and three at stage IVEA. Of the eight testicular lymphomas, six were classed as intermediate grade lymphomas and two as high-grade lymphomas according to the Working Formulation. All of the eight patients received orchiectomy. Six patients received combined chemotherapy and radiation therapy as the primary treatment for the disease. One patient each was treated with radiation therapy alone or combination chemotherapy alone. The 5-year overall and disease-free survival rate was 45 and 33%, respectively. Even though almost all of the patients had received combination chemotherapy, high incidence of relapse in the central nervous system (CNS) was observed. Prophylactic treatment against such recurrence may be necessary to improve the treatment outcome of patients with testicular NHL.

A case of Sjögren's syndrome associated with Sweet's syndrome

We report a case of Sjögren's syndrome whose clinical course had been indolent until the patient presented with Sweet's syndrome (acute febrile neutrophilic dermatosis). This patient showed renal failure and renal tubular acidosis. Sweet's syndrome resolved within 3 weeks without corticosteroid therapy. Renal biopsy findings were consistent with interstitial nephritis. His renal manifestations responded to corticosteroid therapy and the renal function remained stable during 6 years follow-up without recurrence of Sweet's syndrome. Although close association of both syndromes is already known, in our case Sjögren's syndrome may have been exacerbated by occurrence of Sweet's syndrome.