Assessment of regional differences in myocardial blood flow using T2-weighted 3D BOLD imaging

The feasibility of detecting regional differences in myocardial blood flow based on the blood oxygen level-dependent (BOLD) effect was evaluated in vivo in dogs (N = 9) using a 3D T2-prepared segmented gradient-echo sequence at 1.5 T. Regional differences in myocardial blood flow were created by administering adenosine through a catheter placed in the left circumflex coronary artery (LCX). The difference in the R2 (1/T2) relaxation rate between the left ventricular myocardial region supplied by the LCX and regions supplied by the left anterior descending coronary artery (LAD) or septal artery during adenosine administration was correlated to the corresponding regional myocardial blood flow difference determined using fluorescent microspheres. A correlation coefficient of 0.80 was found between the MR BOLD measurements and the myocardial flow assessment. Our results show that the sequence used in this study allows fast 3D BOLD imaging of the heart, and is a promising technique for detecting regional myocardial perfusion differences.

Potent and selective peptide agonists of alpha-melanotropin action at human melanocortin receptor 4: their synthesis and biological evaluation in vitro

alpha-Melanotropin (alphaMSH) and several of its derivatives are potent but not selective agonists at melanocortin receptors 3, 4, and 5 present in the brain (MC3-5R). To differentiate between the physiological role of hMC-4R (believed to be involved in regulation of energy balance) from those of melanocortin receptors 3 and 5, potent and receptor-specific agonists are needed. Therefore, the cyclic derivatives of alphaMSH of a general structure, cyclo(X-His-d-Phe-Arg-Trp-Y)-NH(2), where X is succinic acid or an omega-amino-carboxylic acid, and Y is an alpha,omega-di-amino-carboxylic acid or an omega-carboxy-alpha-amino acid, were prepared and tested in binding assays and in cAMP assays on CHO cells expressing hMC3-5R. Several of the 21-membered or larger lactams turned out to be potent and hMC-4R-selective agonists. For instance, cyclo(CO-CH(2)-CH(2)-CO-His-d-Phe-Arg-Trp-Dab)-NH(2) (Dab: 2,4-di-amino-butyric acid) was a potent agonist at hMC-4R (EC(50) = 4 nM) with 55-fold selectivity over hMC-3R and greater than 1000-fold selectivity over hMC-5R. Another potent and selective compound was cyclo(NH-CH(2)-CH(2)-CO-His-d-Phe-Arg-Trp-Glu)-NH(2): EC(50) about 1 nM at hMC-4R, with 90-fold selectivity over hMC-3R and greater than 2000-fold selectivity over hMC-5R.

Molecular cloning and characterization of a novel peptidylprolyl isomerase (cyclophilin)-like gene (PPIL3) from human fetal brain

During the large-scale sequencing analysis of a human fetal brain cDNA library, we isolated two cDNA clones encoding two novel proteins, which show 52% and 72% identity to the cyclophilin isoform 10 of C. elegans, respectively. Sequence analysis revealed these two cDNA clones are two different splicing variants of a novel cyclophilin-like gene (PPIL3). The PPIL3 gene was identified on a completely sequenced BAC (GenBank accession AC005037) from chromosome 2q33 between STS markers stSG2762 (proximal) and SHGC-3074 (distal), oriented toward the telomere. The PPIL3 gene consisted of eight exons spanning more than 18 kb of genomic DNA. RT-PCR analysis indicated that PPIL3 was ubiquitously expressed in adult human tissues.

The effect of fetal gender on nuchal translucency at 10-14 weeks of gestation

Recent data have suggested that fetal nuchal translucency (NT) is affected by fetal gender. We investigated the size of this effect in 12 189 unselected pregnancies with known normal outcomes that had undergone NT measurements between 10 and 14 weeks of gestation. NT increased with gestation and was converted to multiples of the median (MoM) for the gestational day. The median NT MoM (95% CI) for female fetuses was 0.98 (0.97-0.99). This was significantly lower than that of the male fetuses (1.03; range 1.02-1.04) (p<0.0005; Wilcoxon rank-sum test). The gender difference was not observed at 10 weeks but was observed from 11 weeks onwards. There is no obvious explanation for the above findings.

Risk factors for surgical site infection after elective resection of the colon and rectum: a single-center prospective study of 2,809 consecutive patients

OBJECTIVE

To identify the risk factors for surgical site infection (SSI) in patients undergoing elective resection of the colon and rectum.

SUMMARY BACKGROUND DATA

SSI causes a substantial number of deaths and complications. Determining risk factors for SSI may provide information on reducing complications and improving outcome.

METHODS

The authors performed a prospective study of 2,809 consecutive patients undergoing elective colorectal resection via laparotomy between February 1995 and December 1998 at a single institution. The outcome of interest was SSI, which was classified as being incisional or organ/space with or without clinical leakage. A likelihood ratio forward regression model was used to assess the independent association of variables with SSIs.

RESULTS

The overall SSI, incisional SSI, and organ/space SSI with and without clinical anastomotic leakage rates were 4.7%, 3%, 2%, and 0.8%, respectively. Risk factors for overall SSI were American Society of Anesthesiology (ASA) score 2 or 3 (odd ratio [OR] = 1.7), male gender (OR = 1.5), surgeons (OR = 1.3-3.3), types of operation (OR = 0.3-2.1), creation of ostomy (OR = 2.1), contaminated wound (OR = 2.9), use of drainage (OR = 1.6), and intra- or postoperative blood transfusion (1-3 units, OR = 5.3; >/=4 units, OR = 6.2). However, SSIs at specific sites differed from each other with respect to the risk factors. Among a variety of risk factors, only blood transfusion was consistently associated with a risk of SSI at any specific site.

CONCLUSIONS

In addition to ASA score and surgical wound class, blood transfusion, creation of ostomy, types of operation, use of drainage, sex, and surgeons were important in predicting SSIs after elective colorectal resection.

Cloning and characterization of KLHL5, a novel human gene encoding a kelch-related protein with a BTB domain

Most kelch family proteins contain two conserved domains, the BTB domain and the kelch repeat domain. Here we describe the cloning and characterization of a novel human KLHL5 gene. The 3488 bp cDNA encodes a kelch family protein homologous to the Drosophila kelch protein. It also contains the two conserved domains. Northern blot analysis reveals a single transcript. It is abundantly expressed in ovary, adrenal gland, and thyroid and less abundantly expressed in trachea, prostate, testis, lymph node, and spinal cord. KLHL5 was mapped to 4p13-4p15.1.

Prospective study comparing wounds closed with tape with sutured wounds in colorectal surgery

HYPOTHESIS

To test the efficacy of adhesive paper tape in the closure of clean-contaminated wounds following elective colorectal resection.

DESIGN

A prospective, nonrandomized controlled study.

SETTING

A medical center that offers a mixture of primary, secondary, and tertiary care services.

PATIENTS

The group undergoing skin closure with paper tape (PT group) consisted of 150 patients. The group undergoing skin closure with interrupted suture (IS group) also comprised 150 patients. All 300 patients underwent elective colorectal resection in 1997.

MAIN OUTCOME MEASURES

The duration of skin closure, wound complication rate, and cosmetic appearance of the scar at 6 months after operation were compared using the chi(2)test or t test.

RESULTS

The mean +/- SD average duration of skin closure was 116 +/- 23 seconds for the PT group and 457 +/- 64 seconds for the IS group (P<.01). The wound complication rate was 3.3% (3 cases with wound infection; 2 with wound separation) for the PT group and 3.3% (5 cases with wound infection) for the IS group (P = 1.0). No significant differences were found between the narrowest width (mean +/- SD, 2.2 +/- 0.9 mm vs 2.3 +/- 1.0 mm) and widest width (mean +/- SD, 4.7 +/- 2.0 mm vs 4.3 +/- 1.8 mm) of scar formation between the 2 groups at 6 months after the operation. Ninety-eight percent of patients in the PT group reported satisfaction with their scar, compared with 92% in the IS group (P =.03).

CONCLUSION

Compared with the traditional suture method, paper tape closure in the treatment of clean-contaminated wounds was less time consuming and produced greater patient satisfaction with no increased rate of wound complications.

Mechanism of dissolution of sparingly soluble electrolytes

Recent constant composition dissolution studies of sparingly soluble calcium phosphates have revealed an interesting and unusual behavior in that the rates decreased, eventually resulting in effective suppression, even though the solutions remained undersaturated. Contrary to traditional theories of dissolution, these experimental results indicated the importance of not only the particle size on the dissolution rate but also the participation of critical phenomena. In these theories, it is assumed that when the dissolution reactions are initiated, they continue spontaneously until all solid phase has disappeared. In terms of these mechanisms, there are no critical phenomena in the dissolution mechanism. Although the crystal size decreases during dissolution, when the reaction is controlled by polypitting (formation and growth of pits), the edge free energy increases at the very first stage due to the creation of pits and dissolution steps. The constant composition experimental results demonstrate the development of surface roughness as the dissolution steps are formed, implying an increase of the total edge length during the reactions. In an exactly analogous mechanism to crystal growth, the participation of critical conditions involving dissolution steps is a possibility. In contrast to crystal growth, dissolution is a process of size reduction and, when the particle size is sufficiently reduced, critical phenomena become important so that the influence of size must be taken into consideration. This paper proposes such a model for dissolution reactions, and although these unusual phenomena probably apply to all mineral phases, they are more evident for sparingly soluble electrolytes in which the critical conditions are attained much more readily.

[Application of computer image process to the research on the contact characteristics of subtalar joint]

With the use of computer image processing technology, a new method was proposed for studying the contact characteristics of the subtalar joint. The results showed the total subtalar articulation area was 9.52 +/- 0.40 cm2. On neutral position and under 600 N load, the contact area of the subtalar joint was 2.00 +/- 0.11 cm2. The contact area of the posterior articulation was significantly larger than that of the anterior and medial articulation (p < 0.01). The average contact pressure was 19.3 +/- 1.38 N, the force transmitted by the subtalar was 389.16 +/- 28.75 N, which accounted for about 64.86% of the applied shank load (600 N), and 69.39% of the force was transmitted by the posterior articulation. The posterior articulation plays an important role in the load. The fracture line of the calcaneus often appears in this area.

Cloning, expression, and characterization of a human inosine triphosphate pyrophosphatase encoded by the itpa gene

ITP and dITP exist in all cells. dITP is potentially mutagenic, and the levels of these nucleotides are controlled by inosine triphosphate pyrophosphatase (EC ). Here we report the cloning, expression, and characterization of a 21.5-kDa human inosine triphosphate pyrophosphatase (hITPase), an enzyme whose activity has been reported in many animal tissues and studied in populations but whose protein sequence has not been determined before. At the optimal pH of 10.0, recombinant hITPase hydrolyzed ITP, dITP, and xanthosine 5'-triphosphate to their respective monophosphates whereas activity with other nucleoside triphosphates was low. K(m) values for ITP, dITP, and xanthosine 5'-triphosphate were 0.51, 0.31, and 0.57 mm, respectively, and k(cat) values were 580, 360, and 640 s(-1), respectively. A divalent cation was absolutely required for activity. The gene encoding the hITPase cDNA sequence was localized by radiation hybrid mapping to chromosome 20p in the interval D20S113-D20S97, the same interval in which the ITPA inosine triphosphatase gene was previously localized. A BLAST search revealed the existence of many similar sequences in organisms ranging from bacteria to mammals. The function of this ubiquitous protein family is proposed to be the elimination of minor potentially mutagenic or clastogenic purine nucleoside triphosphates from the cell.

Cell cycle regulatory protein expression in fresh acute myeloid leukemia cells and after drug exposure

Characteristics of treatment-induced cell cycle arrest are important for in vitro and in vivo sensitivity of acute myeloid leukemia (AML) cells to cytotoxic drugs. We analyzed the expression of the major G1 cell cycle regulators (p21Cip1, p27Kip1, cyclins D, cyclin E and pRb) in 41 fresh AML cell samples. The level of p27 expression was the only factor correlated with the response to chemotherapy, a high level of p27 expression being predictive of complete remission. There was a close relation between expression of pRb, cyclin D2 and FAB subtype, illustrated by the absence of both proteins in most samples having a monocytic component (M4, M5). We also assessed the expressions of pRb, cyclin E, p21 and p27 and the activity of cdk2, the major regulator of S-phase entry, after exposure to cytosine-arabinoside (AraC) and daunorubicin (DNR), and found these proteins could characterize time- and dose-dependent cellular response to each drug. We observed hyperphosphorylated pRb, increased levels of cyclin E and a high cdk2 activity, but no p21 induction, in AML cells exposed to 10(-6) M AraC. After exposure to 10(-5) M AraC, corresponding to the serum concentration reached in high-dose AraC regimens (HDAraC), a strong p21 induction was observed, associated with similarly overexpressed cyclin E and even higher cdk2 activity than after 10(-6) M AraC, while apoptosis was significantly increased. These data suggest that cdk2 activity is likely to play a role in AraC-induced apoptosis in AML cells. This mechanism may account for high efficacy of HDAraC in cells showing little sensitivity to conventional AraC doses.

Cloning and expression pattern of the human NDRG3 gene

We report the cloning and expression pattern of a novel N-myc downstream-regulated gene 3 (NDRG3), located on human chromosome 20q11.21-11.23. The NDRG3 cDNA is 2588 base pair in length, encoding a 363 amino acid polypeptide highly related to mouse Ndr3 protein. Northern blot reveals that NDRG3 is highly expressed in testis, prostate and ovary. By in situ hybridization, the NDRG3 mRNA was localized to the outer layers of seminiferous epithelium, indicating that it may play a role in spermatogenesis.

Cloning and characterization of a human lysyl oxidase-like 3 gene (hLOXL3)

Using the PCR primers generated from human expressed sequence tag (EST), the cDNA of lysyl oxidase-like gene 3 (LOXL3), a new member of human lysyl oxidases gene family, was cloned from the human fetal brain mRNA. The predicted amino acid sequence of the hLOXL3 gene was highly homologous to mLOR2. Bioinformatics analysis shows that hLOXL3 protein is also a member of the scavenger receptor cysteine-rich family, which contains a 25 amino acids signal peptide. The hLOXL3 gene was mapped to human 2p13 locus by BLAST search and at least 14 exons were found. Expression of the hLOXL3 gene was detected in several human tissues and especially high in spleen and testis.

Designing a medical Web site

BACKGROUND

A web site is a valuable shop window for any medical unit with something to sell or something to say.

AIMS

The aim of this report is to outline the basic steps of web page design for the individual or unit with limited financial resources.

METHODS

There are two ways of designing a web site. A reputable web design company can be employed, but this is usually expensive. Alternatively, a web site can be designed in-house using commercial software, following a few simple steps. The basic requirements are a personal computer, software that is available on most computers and access to a few peripheral items of hardware. An outline of the page design should first be put down on paper. This can be transferred to a computer file using a web page design program. This file is then sent to a server for publication on the World Wide Web (WWW).

CONCLUSION

Designing and publishing a web page can take time and effort, but the rewards can be great and the results will reflect the message and motto of the unit.

Identification of a human LNX protein containing multiple PDZ domains

Recently PDZ domains have been recognized as crucial organizers of protein complexes at the plasma membrane. Here we report the cloning of a novel 3.7-kb cDNA LNX from a human fetal brain cDNA library. The deduced amino acid sequence shares about 88% identity with the p70 form of Lnx, which is the mouse ligand of Numb protein X. Motif analysis reveals five protein-interaction modules conservative to those in the Lnx protein, including four PDZ domains and a NPXY motif for binding of the Numb PTB domain. Northern blot analysis shows that the length of the transcript in brain is distinct from those in other tissues. By radiation hybrid mapping, we localize the LNX gene to human chromosome 4q12 between marker D4S1577 and marker D4S1594. We predict that LNX may be important for the organization of signaling complexes in Numb-involved pathways or pathways regulated by other PTB-containing proteins.

Molecular cloning, mapping and characterization of the human neurocalcin delta gene (NCALD)

We identified a new human gene that encodes a cognate of the bovine neurocalcin delta from a human fetal brain cDNA library; hence we named it human neurocalcin delta (NCALD) gene. The deduced polypeptide product of the cDNA is 22 kDa in size, and its amino acid sequence is 100% and 99% identical to that of the bovine and chicken neurocalcin, respectively. Northern blots showed that the NCALD gene is more abundantly expressed in brain, testis, ovary and small intestine. Tissue in situ hybridization confirmed the existence of the NCALD mRNA in the adult human testis. Radiation hybrid panel mapping localized the gene to chromosome 8 between molecular markers D8S270 and D8S257.

[Detection of differentially expressed genes in hepatocellular carcinoma using DNA microarray]

Large scale gene expression profiles between normal hepatocytes and hepatocellular carcinomas are detected with high throughput microarray. DNA microarrays were made by spotting PCR products of 4,096 human cDNAs onto a specially treated glass slides. The probes were prepared by labelling normal tissue mRNA and cancer tissue mRNA with Cy3-dUTP and Cy5-dUTP separately through reverse transcription. The arrays were then hybridized against the cDNA probe mixture and the fluorescent signals were scanned. The obtained data were analyzed from 4 repeated experiments. There are 903 genes of which the average ratios between Cy3 signal and Cy5 signal are greater than 3.0. These genes identified through this approach are potential candidates for hepatocellular carcinoma diagnosis and therapy.

Mutations of p53 gene in human colorectal cancer: distinct frameshifts among populations

We analyzed 57 p53 gene mutations in 181 colorectal cancer patients in Taiwan and compiled data on 475 independent p53 mutations in 1,156 primary colorectal cancer patients worldwide between 1992 to 1998. Transitions at the CpG sites were observed in 31 (54%) and 232 cases (49%), respectively. Frameshift mutations occurring within exons were observed in 11 (20%) and 50 cases (10%), respectively. Among the various populations studied, colorectal cancer in Taiwan had the lowest p53 mutation rate (31%), highest frequency (20%) of frameshift mutations and the second lowest rate (13%) of transversion mutation. Based on their relation to the base runs, the 61 frameshift mutations could be grouped into 4 subclasses. After corrections were made for differences in the base number in a run, the relative mutational frequency at a base run was found to be 9- to 47-fold over that in the no-run residues. The p53 frameshift mutational spectrum found in the cases in Taiwan, with respect to hotspot sequence, was significantly different from those in the selected database (p = 0.008). These data support that the patterns of high frequency of transitions at CpG sites and low frequency of transversions in base substitutions in the p53 gene are similar regardless of patient origin. However, these data also illustrate that frameshift mutations in the p53 gene in colorectal cancer patients are sequence dependent and are distinct among populations.

[Clinical application and evaluation of polymerase chain reaction-microwell plate hybridization assay in the detection of Mycobacterium tuberculosis]

OBJECTIVE

To evaluate the clinical application and feasibility of polymerase chain reaction-microwell plate hybridization assay in the detection of Mycobacterium tuberculosis.

METHODS

1130 specimens with strong suspicion for mycobacterium tuberculosis were collected from the hospitals and were detected by fast bacilli stain, culture, PCR-electrophoresis and PCR-microwell plate hybridization respectively. The laboratory results were analyzed in combination with the symptoms and signs of patients and the observations on treatment. Also detected were 100 samples from the clinically evidenced non-tuberculosis patients.

RESULTS

In the 100 samples collected from the patients without tuberculosis, the PCR-hybridization method and culture method did not detect Mycobacterium tuberculosis, but the fast bacilli stain method and PCR-electrophoresis method brought out one and two false-positive results respectively. The results of testing the 1030 clinical samples which probably contained Mycobacterium tuberculosis demonstrated that the PCR-hybridization method had the highest positive rate (481/1030) among the four methods, and the positive rates of the other three methods were PCR-electrophoresis (406/1030), culture (365/1030) and fast bacilli stain (256/1030) in proper order. The chi-square test showed that there were significant difference between the PCR-hybridization method and the other three methods respectively (P < 0.0083 or P < 0.0017).

CONCLUSION

PCR-Hybridization method is specific, sensitive, accurate and fast in detecting mycobacterium tuberculosis; it is worthy to be used clinically.

Cloning and characterization of a novel human leptin receptor overlapping transcript-like 1 gene (LEPROTL1)

A new full-length cDNA encoding a novel protein was isolated from our human fetal brain cDNA library. The cDNA consists of 2701 bp and has a putative open reading frame encoding 131 amino acids which possesses a JAK binding site (Pro(46)-Ile-Pro(48) which is preceded by a cluster of hydrophobic residues) and is highly homologous to the leptin receptor gene-related protein (OB-RGRP). Northern blot analysis showed that this new gene is widely expressed in human tissues and radiation hybrid mapping placed the gene to human chromosome 8p21.1-8p21.2.

Remnant lipoproteins are related to intima-media thickness of the carotid artery independently of LDL cholesterol and plasma triglycerides

Remnants of triglyceride-rich lipoproteins (TRL) have been implicated in the early development of atherosclerosis. We tested this hypothesis by quantifying the plasma concentration of remnant-like particle cholesterol (RLP-C) in a cohort of healthy 50-year-old men in whom the common carotid artery intima-media thickness (CCA-IMT) was assessed by B-mode ultrasound as a surrogate marker for atherosclerosis. The subjects were given a fat-rich meal to study the generation of RLP-C during postprandial lipemia. Fasting plasma RLP-C and other major fasting plasma lipids and lipoproteins were determined twice, and the mean RLP-C concentration was strongly correlated with CCA-IMT (r = 0.32, P = 0.002). In addition, low density lipoprotein (LDL) cholesterol (r = 0.25, P = 0.01) and plasma triglycerides (r = 0.20, P = 0.05) were significantly related to CCA-IMT. Multivariate analyses showed a triglyceride-independent contribution of RLP-C to CCA-IMT. After fat intake, the median plasma RLP-C concentration was doubled after 3 h. The increase was strongly related to the postprandial generation of TRL apolipoprotein (apo)B-48, and large (S(f) 60;-400) TRL apoB-100. The association with CCA-IMT was somewhat stronger for the 3-h RLP-C level than for the fasting RLP-C concentration [r = 0.27, P < 0.01 (3 h) compared with r = 0.22, P < 0.05 (0 h)]. We conclude that the plasma concentration of RLP-C is related to CCA-IMT, independent of plasma triglycerides and LDL cholesterol, in a healthy middle-aged male population. - Karpe, F., S. Boquist, R. Tang, G. M. Bond, U. de Faire, and A. Hamsten. Remnant lipoproteins are related to intima-media thickness of the carotid artery independently of LDL cholesterol and plasma triglycerides. J. Lipid Res. 2001. 42: 17;-21.

[Etiological study on patients with seronegative viral hepatitis]

OBJECTIVE

To investigate the etiology of hepatitis patients who were seronegative for viral hepatitis A through E.

METHODS

By using PCR, HBV DNA, HCV RNA, HEV RNA and HGV RNA were detected in sera of 104 patients with seronegative viral hepatitis. The partial nucleotide sequences of 2 HCV and 17 HEV isolates were analysed by direct sequencing.

RESULTS

Among the 104 patients with seronegative viral hepatitis, the positive rates of HBV DNA, HCV RNA, HEV RNA and HGV RNA were 29.8%, 3.8%, 22.1% and 7.7%, respectively, with only 38 cases (36.6%) negative for the genome of all known hepatitis viruses.

CONCLUSION

In addition to serological tests, the polymerase chain reaction of all known hepatitis viruses should be used to make the diagnosis of non-A - E hepatitis.

Surgical outcome after curative resection of rectal leiomyosarcoma

PURPOSE

The aim of this study is to present the prognosis and possible associated prognostic factors after curative resection of rectal leiomyosarcoma.

METHODS

From 1979 to 1996 our hospital saw 40 patients with rectal leiomyosarcoma, including 19 females, who did not have metastasis initially and received curative resection and regular postoperative follow-up.

RESULTS

The mean age of the 40 patients was 58.7 years. Anal bleeding and perianal pain were the two most common symptoms at initial diagnosis. Twenty-nine patients received a radical surgical resection, such as abdominoperineal resection or low anterior resection; the other 11 patients received a wide local excision, such as transrectal excision or Kraske's operation. Sixteen tumors were classified as high-grade leiomyosarcoma, and 23 as low grade. Nineteen patients (48 percent) developed recurrence or metastasis postoperatively (median follow-up, 35 months). The overall and disease-free (1-year, 3-year, and 5-year) survival rates were 97, 90, and 75 percent and 90, 59, and 46 percent, respectively. In univariate analysis, younger group (<50 years, n = 9, P = 0.033) and high-grade leiomyosarcoma (P = 0.043) showed poorer prognosis in the disease-free survival curve. In the multivariate Cox model, gender, tumor size, tumor location, and operation type did not significantly affect disease-free survival, whereas histologic grade (P = 0.037) and age divided by a level of 50 years (P = 0.009) were shown to be independent factors. There was a strong trend toward higher local recurrence rate for the wide local excision group than for the radical resection group (55 vs. 24 percent, P = 0.067) despite the wide local excision group being composed of smaller tumors (5.1 vs. 7.5 cm, P = 0.069). There was no difference in the incidence of distant metastasis between the two groups with different operation types. The metastasis rates of the wide local excision and radical resection groups were 27 and 38 percent, respectively.

CONCLUSION

A younger age (<50 years) and a high histologic grade of tumor were the two most significant poor prognostic factors for rectal leiomyosarcoma. Radical resection may be superior to wide local excision in the prevention of local recurrence but not distant metastasis.

Primary colorectal lymphoma

PURPOSE

The purpose of this study was to review the clinical presentation and characteristics of primary colorectal lymphoma, analyze the prognostic factors, and assess the results of treatment with adjuvant chemotherapy.

METHODS

We identified 37 cases at our institution between 1980 and 1996. They comprised 0.48 percent of all cases of colon malignancies (37/7,658) during this period. The following clinical information was obtained: age, gender, signs and symptoms, tumor site, tumor size, histology grade, pathology, and adjuvant chemotherapy.

RESULTS

The most common presenting signs and symptoms were abdominal pain (62 percent), abdominal mass (54 percent), and weight loss (43 percent). The most frequent site of involvement was the cecum (45 percent). Histologically, 29 (78 percent) were classified as high-grade, and 8 (22 percent) as intermediate-grade-to-low-grade lymphoma. Nine (24.3 percent) of the cases were Stage EI, 23 (62.2 percent) were Stage EII, and 5 (13.5 percent) were Stage EIV. Twenty-one (57 percent) cases received adjuvant chemotherapy. The five-year survival rate was 33 percent for all patients and 39 percent for patients treated with combination chemotherapy. Overall median survival time was 24 months and 36 months for those with adjuvant chemotherapy. Only histology grade, among the factors examined, was a significant prognostic factor for survival. The mean survival time of the patients with Stage II disease who received chemotherapy was 117.4 months, and it was 47.9 months for the patients with Stage II disease who did not received chemotherapy.

CONCLUSIONS

In our retrospective study high-grade lymphoma was the only significant adverse prognostic factor for survival. Receiving adjuvant chemotherapy significantly improved survival in patients with Stage II disease. Patients with diffuse large-cell type had better survival than patients with small noncleaved-cell type in Stage II high-grade lymphoma.