Extragonadal germ cell tumor followed by metachronous testicular tumor. A case report

We here present a patient with an extragonadal germ cell tumor followed by a metachronous testicular tumor 7 years later. The histological findings of the extragonadal tumor and the subsequent testicular tumor were quite different; the former was of a mixed type with teratoma, embryonal carcinoma and yolk sac tumor, and the latter a pure seminoma. Such a long clinical time lag as 7 years and the histological differences between the two tumors suggest that they occurred independently. To our knowledge, this may be the first case report in the literature, in which a testicular tumor occurred metachronously after extragonadal tumor extirpation.

[Preliminary screening for antiviral AIDS drugs. VII. Report for fiscal year 1994]

Preliminary screening of antiviral AIDS drugs has been carried out using three different in vitro assay systems. Among 246 samples of different origin tested, six were shown to inhibit the growth of HIV in vitro. Two of the positive samples have hopeful signs, as the ranges of effective doses are wider than those of most of positive samples which had been found by us.

DNA ploidy, P53 expression, and cellular proliferation in normal epithelium and squamous dysplasia of non-cancerous and cancerous human oesophagi

Ki67 expression, S-phase fraction, p53 immunoreactivity and DNA content were examined in morphologically normal mucosa and squamous dysplasia of both cancerous and non-cancerous human oesophagi in order to understand possible early events in the development of esophageal squamous cell carcinoma. 103 different foci from cancerous esophagi including 17 non-pathological epithelium, 10 mild, 17 moderate and 15 severe dysplasia, 14 intraepithelial carcinomas and 30 invasive squamous cell carcinomas were examined. Also studied were 57 biopsy specimens from cancer-free individuals, including 12 normal epithelia, 15 oesophagitis, and 16 mild, 11 moderate and 3 severe dysplasia. Areas of squamous dysplasia from both cancer-free and cancerous oesophagi were morphologically indistinguishable and both demonstrated increased cellular proliferation compared to normal or non-pathological epithelia. However, squamous dysplasia in cancerous oesophagi demonstrated significantly larger ki67 labelling indices and smaller S-phase fractions than dysplasia in cancer-free patients. Squamous dysplasia in cancerous and non-cancerous oesophagi demonstrated an non-diploid DNA histogram in 67.9% and 43.3% respectively. However, dysplasia from cancer-free individuals demonstrated a non-diploid pattern with one or more peaks (Type I non-diploid histogram) and that from oesophageal cancer patients predominantly exhibited non-diploid histograms without any distinctive peaks (Type II non-diploid histogram). Significant differences in the frequency of p53 positive foci were observed between dysplasia of cancer-free (23.3%) and cancerous (56.8%) oesophagi. IN cancerous oesophagi, dysplasia associated with Type II non-diploid histograms had a significantly larger number of p53-positive foci than those with diploid histograms or Type I non-diploid histograms. These results indicated that the biological features of squamous dysplasia were different between cancerous and non-cancerous human oesophagi despite indistinguishable morphological features. In addition, the combination of p53 immuno-histochemistry and DNA ploidy analysis may contribute to identify possible high-risk squamous dysplasia of the oesophagus.

The inhibitory effect of the crude extract from a seaweed of Dygenea simplex C. Agardh on the in vitro cytopathic activity of HIV-1 and it's antigen production

The crude water extract (NS-1) from a seaweed (Digenea simplex C. Agardh Rhodomelaceae) exhibited anti-human immunodeficiency virus (HIV)-1 activity in vitro. The inhibitory effect of the extract on the cytopathic activity of HIV-1 and it's antigen production was examined using a microplate method, immunofluorescent assay, and an HIV antigen detection kit (Abbott). NS-1 inhibited both the cytopathic effect of HIV-1 to MT-4 cells and the giant cell formation of Molt-4 cells infected with HIV-1.

White matter changes caused by chronic solvent abuse

PURPOSE

To examine the brain damage of solvent abusers in Japan, where pure industrial toluene is frequently abused.

METHODS

Twenty solvent abusers 17 to 33 years of age with 7.2 +/- 4.0 years of abuse were examined with a 1.5-T MR imaging system.

RESULTS

White matter hyperintensities in cerebrum, brain stem, and cerebellum on T2-weighted images were found in seven cases. The extent of white matter change was most clearly shown on proton density-weighted images. The patients with restricted white matter change and intermediate white matter change showed white matter hyperintensities in the brain stem and cerebellum on T2-weighted images, in some cases, with additional hypointensities in the corresponding T1-weighted images. These patients had mainly abused pure toluene. The patients with diffuse white matter change showed obvious brain atrophy, including hippocampal atrophy and thinning of the corpus callosum. These patients had mainly abused lacquer thinner.

CONCLUSION

There are some patients with restricted but severe enough change to cause the neurologic symptoms in specific regions, such as the brain stem and/or cerebellum, before the brain atrophy becomes apparent. This suggests that the restricted white matter change represents not only an early change of diffuse white matter change, but at least in some cases also represents a qualitatively different change than that of diffuse white matter change. We suggest that pure toluene has a possible relation to this qualitative difference.

[Studies on maternal transmission of HIV-1]

To investigate HIV-1 transmission from mother to child, samples taken from 3 HIV-1 sero-positive pregnant mothers, 3 children born by caesareans from their mothers and therapeutic abortion from 2 HIV-1 sero-positive mothers were tested for HIV-1 antibody by westernblot, p24 antigen by antigen captured ELISA, proviral DNA by Nested-PCR and isolation of HIV-1 virus from peripheral blood, cord blood, amniotic fluid and placenta. HIV-1 proviral DNA was detected in the peripheral blood of all mothers, but p24 antigen and virus isolation were not detected. None of the HIV-1 markers, except for antibody, was detected in the samples from their children and placenta. These facts strongly suggest that there was no HIV-1 transmission from mother to child.

Systemic lupus erythematosus with necrotizing vasculitis and upregulated expression of VLA-4 antigen

We report on a patient (S.A.), with well-defined SLE who developed a perforation of the ileum due to pathologically confirmed necrotizing vasculitis. No anti-DNA antibody was detected at the ileal perforation, and the serum complement level was normal. These findings raise the alternative possibility of a cell-mediated immune mechanism as a cause of necrotizing vasculitis. Upregulated expression and function of VLA-4 antigen on peripheral blood T cells were observed, suggesting that T cells with VLA-4 antigen may participate in the onset and/or perpetuation of vascular inflammation.

Renal papillary necrosis caused by urinary calculus-induced obstruction alone

We report a case of renal papillary necrosis in a 18-year-old female. Urinary tract obstruction induced by a calculus seems to be the only etiologic factor in this case, although the multifactorial nature of this lesion has been stressed.

Abuse of smoking methamphetamine mixed with tobacco. III. Urinary metabolites of N-cyanomethylmethamphetamine, a pyrolysis product formed by smoking methamphetamine in tobacco, and species difference in its metabolism between rat and mouse

1. N-cyanomethylmethamphetamine (CMMA) or methamphetamine (MA) was given intraperitoneally to rat and mouse (1, 3, 10 mg/kg). The basic urinary metabolites of CMMA were determined by mass spectrometry (MS) and compared with those of MA. 2. N-formylmethamphetamine (FMA), a specific metabolite of CMMA, was found in both rat and mouse urine. However, the dose percentage of FMA excreted in mouse urine was less than one-quarter of that in rat urine. 3. No CMMA was detected in rat or mouse urine collected within 72 h after dosing. All other basic metabolites of CMMA except FMA, i.e. MA, amphetamine (AP), p-hydroxymethamphetamine (OHMA) and p-hydroxyamphetamine (OHAP), were the same as those of MA in both species. 4. The excretion pattern of the urinary metabolites of CMMA was similar to that of MA except FMA in both species, though the amount of each metabolite of MA administration was larger than that of CMMA administration. However, in urinary excretion of FMA and hydroxylated metabolites, definite species differences were observed between rat and mouse. 5. A trace amount of FMA was identified in the urine of an abuser who had smoked MA with tobacco.

[Prognostic factors of radiation therapy for patients with non-operative stage III non-small cell lung cancer]

Records of patients with non-operative stage III non-small cell lung cancer registered at the Department of Radiotherapy, Cancer Institute Hospital, from January 1978 to June 1980 were examined in order to present prognostic information on survival. The data were derived from 100 carefully staged patients and include results from the patients' history, physical examination, pretreatment laboratory tests, radiological findings, nature of radiotherapy and response to treatment. Serum albumin, tumor site, performance status (PS), hemoglobin, TDF and response were identified as important prognostic factors in the univariate analyses. On the other hand, tumor site, PS and serum albumin were significantly related with survival in the multivariate analyses. However it was found that TDF and response significantly affected survival when posttreatment variables were taken into account. These patients were classified into low, intermediate and high risk groups according to those three pretreatment factors (tumor site, PS and serum albumin), and the median survival times for the groups were 10.3 months, 10.4 months and 2.5 months, respectively. These results suggest that high risk patients with stage III non-small cell cancer generally might be treated palliatively.

Intravesical mitomycin C and doxorubicin sequential therapy for carcinoma in situ of the bladder: a longer followup result

A total of 43 patients with carcinoma in situ of the bladder (primary in 26 and secondary in 17) who underwent intravesical mitomycin C and doxorubicin sequential therapy for 2 multicenter studies were followed for a median period of 45 months (range 10 to 84). Of the patients 32 (74%) achieved complete response after induction therapy and underwent maintenance therapy with either mitomycin C plus doxorubicin, mitomycin C alone or observation only. Of the complete responders 13 (41%) had a local recurrence, and subsequent repeat intravesical mitomycin C and doxorubicin sequential therapy as well as bacillus Calmette-Guerin was effective in a significant proportion (75% or greater). The maintenance therapy did not have a favorable effect on the recurrence rate. In 8 patients (19%) (3 of 32 complete responders and 5 of 11 nonresponders) progression developed, including invasive cancers in 4, metastatic disease in 2 and both conditions in 2. Initial complete responders had a significantly higher progression-free rate than initial nonresponders, although there was no difference in the sites of progression between them. At the last followup 35 patients (81%) remained free of disease with 31 (72%) having a normally functioning bladder. According to these results, intravesical mitomycin C and doxorubicin sequential therapy appears to be applicable as initial treatment for carcinoma in situ of the bladder.

Upregulated expression and function of integrin adhesive receptors in systemic lupus erythematosus patients with vasculitis

Upregulation of integrin adhesive receptors has been implicated in various pathological conditions. We examined expression and function of integrin adhesive receptors on peripheral blood lymphocytes from patients with systemic lupus erythematosus (SLE), particularly those with the complication of vasculitis, and found that VLA-4 and LFA-1 expression was increased in SLE patients with vasculitis, while LFA-1 but not VLA-4 expression was increased in those without vasculitis. These results suggested a role of VLA-4 in the pathogenesis of vasculitis in SLE. Functional studies further demonstrated that adhesion to cytokine-activated human umbilical cord vein endothelial cells and to the CS-1 alternatively spliced domain of fibronectin was significantly increased in SLE patients with vasculitis. Analysis of the functional epitopes on the alpha 4 chain demonstrated that antigen densities of all the functional epitopes were increased in those with vasculitis, indicating that the increased expression of VLA-4 resulted from the increased number of VLA-4 molecules, and was not secondary to an increase in one particular functional epitope. Immunoprecipitation studies further support these results. Interestingly, high molecular weight bands associated with VLA-4 were observed in about half of the SLE patients with vasculitis. These results introduce a possibility that upregulation of integrin adhesive receptors has a potential role in the pathogenesis of vasculitis in SLE.

Functioning survival rate of the fixture and superstructure of osseointegrated implants (first report)

Osseointegrated implant bridges (OIB) have shown excellent progressing in the majority of cases. Since 1983, OIBs has been used to treat about 110 cases in Tokyo Dental College Hospital with more than 500 fixtures. The survival rate of OIB, especially the functioning survival rate of these fixtures, is described, herein. The survival rate of the superstructure of OIB has been almost 100% in both maxilla and mandible. However, the functioning survival rate of OIB fixtures was 88% in maxillary cases and 96% in mandibular cases at less than 1 year. Very few fixtures had to be removed after more than 1 year in either maxilla or the mandible. It appears that the functioning survival rate of OIB fixture is generally decided during the period just between connecting these components and 1 year. A few fixtures may need to be removed later.

[Intra-arterial CDDP and CDDP plus THP-ADM therapy for bladder cancer]

From 1983 to 1988, 20 patients (group A: 3 stage T1, 4 stage T2 and 13 stage T3-4 tumors) with bladder cancer were treated with single injection of CDDP (150-200 mg/body), and 28 patients (group B: 4 stage T1, 9 stage T2 and 15 stage T3-4 tumors) were treated twice with injection of CDDP (100 mg/m2) and THP-ADM (40 mg/m2) mixture from the internal iliac artery. As a rule, one half of the agents was equally given for the both sides, while 75% dose was given to the tumor side to the case with unilateral localized tumors. Then total or partial cystectomy was followed. When residual invasive cancer was pathologically present in operative specimens, patients underwent three to six courses of adjuvant chemotherapy including CDDP. Clinical response rate (CR+PR) to the intra-arterial chemotherapy in group A and B were 39% and 62%, respectively. Pathological response rate (grade 3 and grade 4 by Oboshi and Shimozato classification) were 17% in both group. After total cystectomy, the 2-year cancer specific survival rates of 17 patients in group A and 22 patients in group B were 75% and 59%, respectively. The 2-year cancer specific survival rates of 8 patients in group A and 10 patients in group B with pT3b were 63% and 54%, respectively. No cancer death occurred thereafter in the patients of group A during another three years. The 3-year cancer specific survival rate of 9 patients after partial cystectomy (3 in group A, 6 in group B) was 86%.(ABSTRACT TRUNCATED AT 250 WORDS)

Human urinary excretion of L-histidine-related compounds after ingestion of several meats and fish muscle

1. After oral administration of the muscle of skipjack tuna, about 90% of ingested anserine (Ans) was excreted quickly into urine as Ans (8%) and pi-methylHis (82%), indicating the fast decomposition of Ans into pi-methylHis. This was also the case for chicken muscle ingestion. 2. After eel muscle ingestion, carnosine (Car) excretion was only 1% of the ingested whereas almost no increase was found in His, a constituent of Car, indicating the re-utilization of this essential amino acid. Similar results were also obtained from beef and pork ingestion. 3. In all cases, the urinary excretion of these compounds reached a maximum within 7 hr after ingestion and returned to the level of meat-free diet within 40 hr.

Patients infected with human immunodeficiency virus type 1 have low levels of virus in saliva even in the presence of periodontal disease

In two consecutive studies, 80 subjects human immunodeficiency virus (HIV)-1-seropositive (21 asymptomatic, 6 persistent generalized lymphadenopathy, 13 AIDS-related complex, and 40 AIDS) were examined for oral lesions. Paired serum and saliva specimens were tested for HIV isolation, DNA, and antigen. HIV antigen was detected in sera from 31 patients, but not in saliva. HIV was isolated from blood mononuclear cells of 83% and saliva supernatants of 21%. In the second study of 25 patients, HIV was detected in plasma of 56% (titers, 1/10 to > 1/1000) but not in diluted saliva supernatants, even in those with severe periodontal disease. HIV DNA was detected using polymerase chain reaction in 2 of 7 saliva cell pellets and 4 of 5 blood samples. Hence, infectious HIV and DNA was found at very low concentrations in 21% and 28% of HIV-seropositive patients, respectively, at all stages of HIV infection.

Benign polyp with prostatic-type epithelium in the anterior urethra accompanied with urethral stricture

Benign polyp with prostatic-type epithelium in the anterior urethra is rare. We present a case of the same lesion accompanied with urethral stricture. A literature review and discussion of this rare entity are also presented.

[Dual nuclides SPECT for ventilation and perfusion study]

Dual nuclides SPECT using 81mKr and 99mTc-MAA for ventilation and perfusion study was performed in 24 subjects. Crosstalk of 81mKr to 99mTc-energy window was about 7.5% when ventilation and perfusion study were performed by 370 MBq of 81mKr gas and 185 MBq of 99mTc-MAA. Areas of low V/Q was significantly larger in SPECT study than in planar study, in 11 cases with various pulmonary diseases. High V/Q mismatches were also more clearly delineated in SPECT than in planar study. Dual nuclides SPECT study has advantages of obtaining V/Q distribution without movement artifacts and of simultaneous acquisition of ventilation and perfusion image. Area of high V/Q became larger in SPECT with crosstalk than in SPECT without crosstalk, but in the low V/Q area no significant difference was noted between SPECT with crosstalk and without crosstalk.

[Asymptomatic multilocular cystic renal cell carcinoma]

From January 1982 to December 1989, we experienced seven multilocular cystic renal cell carcinomas (MLCRCCs) in 36 asymptomatic renal cancers incidentally diagnosed, and none in 23 symptomatic renal cancers (p less than 0.05). No multiocular cystic nephromas (MLCNs) appeared in either group. Though MLCRCCs have been considered to be, in general, extremely rare, they do occur in asymptomatic renal cancers. A multiloculated renal mass with thick septum discovered in an adult by ultrasonography or CT scan should be suspected as being a MLCRCC rather than a MLCN.

[A study on the disc sensitivity test for cefodizime]

Susceptibilities of 289 strains of 34 bacterial species to cefodizime (CDZM) were determined using the 2-fold agar dilution method in parallel with the measurement of inhibition zone diameters in the single-disc method under the experimental conditions established by Kanazawa. The experiments demonstrated a significant correlation between MIC by the dilution method and diameter of inhibition zone in each of the conventional, overnight assay (about 16 hours incubation), thus the applicability of the single-disc assay for CDZM was established. Analysis of the data obtained using discs containing 30 micrograms of CDZM/disc revealed that the primary regression equation was in the form: D (Diameter, mm) = 32.3-13.5 log MIC (micrograms/ml) in the conventional assay for staphylococci, Enterococcus group and glucose-non-fermentative Gram-negative rods. For other bacteria, the primary regression equation was in the form: D (diameter, mm) = 24.1-8.4 log MIC (micrograms/ml) in the conventional assay. The range of variations in MICs estimated from diameters of inhibition zones in the disc test was then calculated in comparison with that in MIC determined by the 2-fold agar dilution test to estimate experimental errors which may be involved in the determination of MICs of CDZM using the single-disc assay.

[Neoadjuvant intra-arterial chemotherapy followed by partial cystectomy for invasive bladder cancer]

From January, 1987 through January, 1990, partial cystectomy was performed for 4 (18%) of 22 patients with invasive bladder cancer who had received neoadjuvant intra-arterial chemotherapy. The criteria of patient selection for partial cystectomy were: 1) invasive bladder cancer showing good response (greater than or equal to PR) to neoadjuvant chemotherapy, 2) solitary or localized tumor that can be eradicated by segmental resection, and 3) tumor of stage T3 or less. As a rule, cisplatinum (100 mg/m2) and THP-adriamycin (40 mg/m2) were administered selectively to the internal iliac artery by one-shot infusion. Concurrently, sodium thiosulfate (10 g/m2), a neutralizing agent against cisplatinum, was administered intravenously. All four patients had achieved clinical complete responses by one or two courses of intra-arterial chemotherapy, and then underwent partial cystectomy with pelvic lymphadenectomy. Pathological examination revealed pTONO in two patients, and the remains were pT3aNO and pT3bN1. After the mean follow-up of 24 months, three of them are alive with no evidence of disease, and also with normal bladder and sexual functions. However, one with pT3bN1 tumor underwent total cystectomy 5 months later for local recurrence (pT4b) and had died of cancer 18 months later. Neoadjuvant intra-arterial chemotherapy followed by partial cystectomy should be the most applicable conservative therapy with high radicality for invasive bladder cancer, when: 1) the patient has localized invasive cancer showing good response (greater than or equal to PR) to neoadjuvant chemotherapy, 2) the tumor is stage T3a or less and without findings of tentacular invasion (INF gamma) by pre-operative biopsy, and 3) pre-operative multiple biopsy is performed as deeply as possible along the prearranged incision line.

Intravesical combination chemotherapy with mitomycin C and doxorubicin for superficial bladder cancer: a randomized trial of maintenance versus no maintenance following a complete response

Between November 1986 and April 1989, 101 patients with superficial bladder cancer were treated with intravesical instillations of mitomycin C on day 1 and doxorubicin on day 2 of each week for 5 consecutive weeks. Of 61 complete responders, 23 patients with carcinoma in situ and 28 with papillary cancer were randomly assigned to a non-maintenance group or to a group receiving maintenance therapy consisting of monthly instillations of the same drugs for 12 months. The 2-year non-recurrence rate calculated for patients with carcinoma in situ was significantly better in the maintenance group than in the non-maintenance group. A similar tendency was observed for patients with papillary cancer, although the difference was not significant. Side effects were considerable, with moderate to severe bladder irritation occurring in approximately half of the patients. In addition to our previous findings, the present results indicate that this intravesical combination chemotherapy is effective in eliminating superficial bladder cancers and that since the effect is not durable, even in complete responders, maintenance therapy is necessary to reduce subsequent tumor recurrence.

[A study on the disc sensitivity test for cefpirome]

Susceptibilities of 232 strains of 40 bacterial groups to cefpirome (CPR) were determined by the 2-fold agar dilution method in parallel with the diameter of inhibition zones by the single-disc method under the experimental conditions established by Kanazawa. The experiments demonstrated a significant correlation between MIC by the dilution method and diameter of inhibition zone in each of the conventional assay of over-night (about 16 hours) incubation, the delayed assay (about 24 hours incubation), and the rapid assay (about 3-4 or 5-6 hours incubation), thus confirming the applicability of the single-disc assay for CPR. Analysis of the data obtained by using CPR disc containing 30 micrograms revealed the primary regression equation to be: D (diameter, mm) = 26.7-9.2 log MIC (micrograms/ml) in the conventional assay, D = 33.8-12.7 log MIC (micrograms/ml) in the delayed assay, D = 21.2-6.7 log MIC (micrograms/ml) in 5-6 hours rapid assay, and D = 14.8-4.1 log MIC (micrograms/ml) in 3-4 hours rapid assay. The range of variations in MICs estimated from the diameter of inhibition zone by the disc test was then calculated in comparison with that in MIC determined by the 2-fold agar dilution test, as a reference for the experimental errors which may be involved in the estimation of MIC of CPR by the single-disc assay.