Prognostic factors and a predictive model of follicular lymphoma: a 25-year study at a single institution in Japan

The incidence of follicular lymphoma in Japan is far lower than that in western countries, and no large-scale clinicopathologic studies on this neoplasm have been conducted in Japan. We reviewed histopathological specimens from 118 of 135 patients who had been diagnosed as having follicular lymphoma between 1968 and 1993. Prognostic factors influencing survival were analyzed using univariate and multivariate analyses. Factors that were independently significant upon multivariate analysis were incorporated into a predictive model. Ninety-three patients (78.8%) had a confirmed diagnosis of follicular lymphoma. Twenty-one of the remaining 25 patients were categorized as having other lymphoma subtypes, and four patients showed indefinite findings or those suggesting diseases other than lymphoma. Major characteristics of the 93 patients with follicular lymphoma were a median age of 53 years (20-85); 59 males (63%) and 34 females (37%); small cleaved cell type in 33 (35%), mixed cell type in 41 (44%) and large cell type in 19 (20%); stage I/II in 41 (44%) and stage III/IV in 50 (54%). Overall survival was 71% at 5 years, 58% at 10 years, and 43% at 15 years with a median survival of 13.3 years. Multivariate analysis revealed that two variables, age (>60) (P=0.001) and the serum LDH level (>1 x normal value) (P=0.026), were unfavorably significant prognostic factors influencing survival. The predictive model using these two variables identified three risk groups with estimated five-year survival rates of 88.5%, 56.8%, and 31.5%. Age and serum LDH were significant predictors of survival in Japanese patients with follicular lymphoma. Our predictive model may provide a basis for future therapeutic trials against follicular lymphoma in Japan.

Differences in dopamine efflux induced by MPP+ and beta-carbolinium in the striatum of conscious rats

The effects of N-methyl-4-phenylpyridinium cation (MPP+) and of an endogenously formed analog, 2,9-di-methyl-norharmanium cation (2,9-Me2NH+), on extracellular dopamine were studied in the striatum of freely moving rats. Perfusion of either 2,9-Me2NH+ or MPP+ through a microdialysis probe evoked a marked and dose-dependent increase of dopamine levels. Tetrodotoxin and Ca(2+)-free medium prevented the increase in dopamine levels induced by 2,9-Me2NH+, but not that induced by MPP+. Cocaine, 3 microM, intensified the 2,9-Me2 NH(+)-induced increase in extracellular dopamine and slightly attenuated the MPP(+)-induced efflux. S(-)-3-(3-Hydroxy-phenyl)-N-propylpiperidine, that acts as an antagonist of dopamine autoreceptors in the presence of a dopamine reuptake inhibitor, markedly enhanced the increase in extracellular dopamine elicited by 2,9-Me2NH+, but not that by MPP+. These results suggested that 2,9-Me2NH+ was a potent dopamine reuptake blocker, whereas MPP+ acts as an amphetamine-like dopamine releaser rather than a reuptake inhibitor on the membrane transporter.

[MR imaging of the femoral marrow in adult acute leukemia: correlation of MRI patterns with FAB subtype and prognosis]

MR imaging of the femoral marrow was performed in 36 patients with untreated acute myeloid leukemia (AML) and 7 patients with acute lymphocytic leukemia (ALL). The MRI appearance was classified into five patterns: 1) fatty marrow; 2) faint signal; 3) nodular pattern; 4) heterogeneous infiltration; and 5) diffuse infiltration. The MRI patterns of the femoral marrow were compared among the FAB subtypes of acute leukemia, and the MRI patterns were correlated with prognosis. All five MRI patterns were observed in the femoral marrow in adult acute leukemia, and diffuse infiltration was most commonly seen (41.9%). A completely fatty marrow was also depicted in two cases (4.7%) and faint signal in four cases (9.3%) in spite of untreated acute leukemia. The M2 subtype of AML tended to be demonstrated as a minimally abnormal MRI finding, which was significantly different from the other types of AML. The patients who showed fatty marrow or faint signal were thought to have a good prognosis, while diffuse or heterogeneous infiltration was regarded as a poor prognostic sign. However, there were some exceptions to these rules, and no significant differences were revealed in prognosis between minimally abnormal and advanced MRI patterns. We concluded that MRI of the femoral marrow could be useful in the assessment of tumor volume of adult acute leukemia, and that there were limitations to predicting prognosis on the basis of the MRI manifestations.

[Clinical study of a macrolide antibiotic, azithromycin, in pediatric patients]

Azithromycin (AZM), 10% fine granules or 100 mg capsules, were given orally to 27 children with various pediatric infections. The results of the study are shown below. 1. Pharmacokinetic investigation. We studied plasma and urinary concentrations after 100 mg AZM capsules were given. One patient received 8.3 mg/kg of AZM once a day for 3 days, and AZM concentration in plasma was 0.033 microgram/ml 48 hours after the final dosing. Doses of 8.3 and 12.5 mg/kg body weight of AZM were respectively given to two patients once daily for 3 days. As a result, AZM concentrations in urine during a period between 96 and 120 hours post-dosing were 1.67 and 4.53 micrograms/ml, respectively, and urinary excretion rate in 120 hours after the first dosing was 10.54% in the patient that was given 12.5 mg/kg. 2. Clinical investigation. Clinical efficacies were examined in 24 patients. Excellent results were obtained in 7 patients, good results in 14 patients, hence the clinical efficacy rate was 87.5%. Bacteriologically, Haemophilus influenzae strains isolates from 2 patients were eradicated in 1 and decreased in the other. Safety was evaluated in 26 patients. An adverse reaction was observed in 1 patient (urticaria). Abnormal laboratory test results were observed in 2 patients, decreased WBC in 1 and elevation of eosinophils in the other. The above results suggest that AZM is a useful oral antibiotic for pediatric patients with infection with susceptible organisms.

Rapid diagnosis of methicillin-resistant Staphylococcus aureus bacteremia by nested polymerase chain reaction

OBJECTIVE

The purpose of this study was to establish a rapid and sensitive diagnostic method for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia in postoperative patients.

SUMMARY BACKGROUND DATA

As a result of diffusion and abuse of third-generation cephalosporin antibiotics in the 1980s in Japan, an outbreak of MRSA infection has been posed. In the field of surgery, severe postoperative infections with MRSA such as MRSA bacteremia, which may lead to multiple organ failure, have emerged with a high mortality.

METHODS

Thirty-five patients with high fever (above 38.5 C) or watery diarrhea or both within 2 weeks after gastrointestinal major surgery and 6 healthy volunteers were examined. Nested polymerase chain reaction was used to detect mecA and toxic shock syndrome toxin-1 (TSST-1) genes in blood specimens.

RESULTS

The mecA and TSST-1 genes were not detected in the blood samples of any of the six healthy volunteers. In all 12 samples from which MRSA colonies were isolated by blood culture, mecA and TSST-1 genes were detected. Although it took at least 48 hours to identify MRSA by the blood culture method, the presence of mecA and TSST-1 genes was determined by nested polymerase chain reaction method within only 3 to 4 hours after blood sampling.

CONCLUSIONS

This method, as a sensitive and rapid monitoring system for MRS bacteremia, would be clinically beneficial for prevention of cross infection and for early determination of appropriate treatment for infected patients.

Genetic controls of susceptibility and resistance to 4-nitroquinoline 1-oxide-induced tongue carcinomas in rats

We analyzed the incidence of infiltrative mass-type tongue carcinomas (IMTC) induced in 550 rats by continuous oral administration of 0.001% 4-nitroquinoline 1-oxide solution for 180 days. The study included various crosses of susceptible Dark-Agouti rats (DA) and resistant Wistar/Furth rats (WF). DA showed a 93.6% incidence of IMTC measuring more than 5 mm in their largest diameter, while WF showed only a 4% incidence. Reciprocal F1 and F2 hybrids mated by DA and WF showed 47.5% and 45.8% incidences, respectively. Meanwhile, reciprocal backcrossed hybrids to DA and WF showed 73.7%, and 24.6% incidences, respectively. Segregation of the incidences suggests that there are two autosomal dominant genes, one linked to the susceptibility of DA and the other to the resistance of WF.

Effect of(12)C (+5) ion beam irradiation on cell viability and plant regeneration in callus, protoplasts and cell suspensions ofLavateva thuringiaca

The biological effects of irradiation with(12)C(+5) ion beam on plant cells have been analyzed. Protoplasts and cell suspensions ofLavatera thuringiaca, and a somatic hybrid callus (Hibiscus rosa-sinensis +Lavatera thuringiaca), were irradiated with doses from 0.05 to 50 Gy, and the effects on cell growth, cell division, cell viability and embryogenesis rates were analyzed. Irradiation with(12)C(+5) ion beam at relatively very low doses (5.0 Gy) significantly inhibited cell division, yet the survival rate and regeneration capability of the cells through somatic embryogenesis were conserved in more than 70 and 50 %, respectively. These results indicate that cell division is the most sensitive parameter to irradiation, accounting for the inhibition of colony formation and callus growth. The potential use of the(12)C(+5) ion beam in asymmetric protoplast fusion experiments is discussed.

[Changes in serum Lp(a) and apo(a)phenotype in patients with acute cerebral stroke]

33 patients with acute cerebral stroke (21 men and 12 women, averaged age 69.9 +/- 11.2 years) were examined for fluctuations in the level of serum Lp(a) 3, 7, 14, and 28 days after the onset of symptoms. The Lp(a) level was higher (p < 0.05, p < 0.001) on days 7 and 14 than on the day of onset. Higher values were associated with poorer outcomes and with larger abnormal densities on brain CT scans. In 33 of these patients, the apo(a)phenotype was determined. Diluted serum was electrophoresed with SDS-containing gel as a carrier, then transcribed on a nitrocellulose membrane, stained by Western blotting and then sensitizing-stained. The results were evaluated by the method of Utermann et al. Outcome was significantly poorer in patients with a double-band apo(a)phenotype than in those with a single-band (p < 0.05). Those with a double-band had significantly higher mean value of Lp(a), except on the day of onset, than did those with a single-band. Patients with large degrees of electrophoresis had significantly higher values of Lp(a) than did those with small degrees. These data suggest that serial measurement of Lp(a) can be of some value in predicting the outcome in patients with cerebral stroke. Determination of apo(a) phenotype may also be useful in the prevention and prognosis of cerebral stroke, especially when it is caused by cerebral infarction.

Mitral valve dysfunction resulting from thickening and stiffening of artificial mitral valve chordae

BACKGROUND

There is little information about changes in mitral valve function caused by thickening and stiffening of artificial chordae during follow-up. Using serial echocardiographic examination, we evaluated thickening and stiffening of artificial chordae and the effect of those changes on mitral valve function.

METHODS AND RESULTS

Between November 1986 and November 1993, 40 patients underwent mitral valve repair with artificial chordae using glutaraldehyde-tanned xenograft pericardium (GTXP) or polytetrafluoroethylene suture (PTFE). Seven GTXP patients and 20 PTFE patients underwent serial echocardiographic examination after surgery and were included in the final analysis. Thickening and stiffening of the artificial chonlae were classified according to echocardiographic changes after surgery: grade 1, no change; grade 2, thickening and/or stiffening without impairment of the motion of the mitral valve leaflet; and grade 3, thickening and stiffening that impaired motion of the mitral valve leaflet. The mean follow-ups in patients with GTXP and PTFE were 6.0 and 3.6 years, respectively. During follow-up, there were 2 GTXP patients with grade 2 thickening and stiffening and 4 patients with grade 3. There were 6 PTFE patients with grade 2 thickening and stiffening and 2 patients with grade 3. Grade 3 occurred earlier in GTXP than in PTFE patients (P < .05). Mitral valve area in GTXP patients decreased from 2.5 +/- 0.4 to 2.1 +/- 0.3 cm2 (P < .05); however, mitral valve area in PTFE patients showed no significant change during follow-up (2.1 +/- 0.4 to 2.0 +/- 0.4 cm2, P = NS).

CONCLUSIONS

Although mitral valve repair with artificial chordae is useful, more attention should be paid to mitral valve function resulting from thickening and stiffening of artificial chordae.

Systematic sequencing of the 283 kb 210 degrees-232 degrees region of the Bacillus subtilis genome containing the skin element and many sporulation genes

As part of the Bacillus subtilis genome sequencing project, we have determined a 283 kb contiguous sequence from 210 degrees to 232 degrees of the B. subtilis genome. This region contains the 48 kb skin element which is excised during sporulation by a site-specific recombinase. In this region, 310 complete ORFs and one tRNA gene were identified: 66 ORFs have been sequenced and characterized previously by other workers, e.g. acc, ans, bfm, blt, bmr, comE, comG, dnaK, rpoD and sin operons; cwiA, gpr and lysA genes; many sporulation genes and operons, spo0A, spoIIA, spoIIM, spoiiP, spoIIIA, spoIIIC, spoIVB, spoIVCA, spoIVCB and spoVA, etc. The products of 84 ORFs were found to display significant similarity to proteins with known function in data banks, e.g., proteins involved in nucleotide metabolism, lipid biosynthesis, amino acid transport (ABC transporter), phosphate-specific transport, the glycine cleavage system, the two-component regulatory system, cell wall autolysis, ferric uptake and sporulation. However, the functions of more than half of the ORFs (52%, 160 ORFs) are still unknown. In the skin element containing 60 ORFs, 32 ORFs (53%) encode proteins which have significant homology to gene products of the B. subtilis temperate phage phi 105 and/or the defective phage PBSX.

Inhibition of adenylyl cyclases by 12(S)-hydroxyeicosatetraenoic acid

The inhibition of adenylyl cyclase (AC) by a 12-lipoxygenase metabolite of arachidonic acid, 12(S)-hydroxy-5Z,8Z,10E,14Z-eicosatetraenoic acid (12-HETE), was investigated using three different kinds of cells: NRK-49F (normal rat kidney fibroblasts), AtT-20 (mouse pituitary tumor cell line) and HL-60 (human leukemia cells) cells. The inhibition was very obvious in NRK-49F and AtT-20 cells, but it was almost negligible in HL-60 cells. There was no difference in terms of the binding of 12-HETE to NRK-49F and HL-60 cells. Pretreatment of NRK-49F cells with pertussis toxin almost completely ADP-ribosylated Gi proteins, but it did not affect the inhibition of 12-HETE on AC in this cell. This result excludes the involvement of Gi proteins in 12-HETE-mediated inhibition of AC. It was revealed that the characteristics of ACs in these cells were quite different in response to agonists and forskolin, suggesting that these cells do have different isoform of AC. We conclude that 12-HETE inhibits the activity of AC depending upon the isoform.

Selective slow pathway ablation in atrioventricular nodal reentrant tachycardia--comparison of different methods and the site of slow pathway ablation

The optimum potential of the slow pathway (SP) was investigated by determining the effectiveness and safety of high-radiofrequency catheter ablation to treat atrioventricular nodal reentrant tachycardia (AVNRT). The subjects consisted of 29 patients with AVNRT (11 men, with a mean age of 54 +/- 15 years). Three ablation methods were used: a) Method A used the earliest atrial activation site, which is retrograde to the slow pathway, b) Method SP used the SP potential, and c) Method SW, in which ablation was performed stepwise starting from the coronary sinus and moving toward the recording site of the His bundle potential. Five, 20, and 4 patients underwent Methods A, SP, and SW, respectively. The fewest number of applications was needed with Method SP (11 +/- 9, 6 +/- 4, and 13 +/- 9), and the delivered energy was also lowest with Method SP (9151 +/- 6119, 3712 +/- 2168, and 12183 +/- 4090 J, with Methods A, SP, and SW, respectively). In Method SP, the interval between the atrium and SP was significantly longer at sites which cured tachycardia, than at sites at which ablation was ineffective (88 +/- 26 vs 66 +/- 22 msec, p < 0.05). The SP potential showed a humped shape in 18 of 20 patients. Method SP was the most efficient ablation method for treating AVNRT.

Central projections of primary afferent fibers from the rat trigeminal nerve labeled with isolectin B4-HRP

The central projections of unmyelinated primary afferent fibers from the rat trigeminal nerve were investigated using retrograde and transganglionic transport of isolectin B4-horseradish peroxidase (B4-HRP). After the injection of a small amount of the tracer into various areas of the facial dermis and oral mucosa, small neuronal somata were retrogradely labeled in the trigeminal ganglion. Clearly delineated transganglionic labeling was observed exclusively in lamina II of the medullary and upper cervical dorsal horn. Its distribution showed a somatotopic organization. Fibers from the oral mucosa terminated in the region 0-1.7 mm caudal to the obex, whereas those from the facial skin terminated in the region from 1.3 mm caudal to the obex through the second cervical segment. In each of these two terminal regions, the rostral areas in the periphery were represented more rostrally than the caudal areas, and the dorsal areas in the periphery were represented more ventrolaterally than the ventral areas.

Circadian changes in urine volume and frequency in elderly men

PURPOSE

Circadian changes in urinary frequency, diuresis and bladder capacity were evaluated in middle-aged and elderly patients.

MATERIALS AND METHODS

A total of 2,703 urinations from 50 men (median age 66 years) was recorded with a 24-hour uroflowmetry system.

RESULTS

During a 24-hour period the elderly group showed increased frequency and decreased bladder capacity. No difference was observed in diuresis between the 2 age groups. From midnight to 6 a.m. frequency in the elderly group was significantly greater (p < 0.01) than that in the middle-aged group.

CONCLUSIONS

Increased frequency in the elderly group during these hours was primarily due to an increase in diuresis.

[Therapeutic efficacy of azithromycin in pediatrics]

Azithromycin (AZM), a newly developed azalide antibiotic, was administered at a standard dose of 10 mg/kg once daily for 3 days to pediatric patients with bacterial infections and the therapeutic efficacy of AZM was investigated. 1. A total of 12 patients with the following diseases was evaluated: pharyngitis in two, tonsillitis in four, bronchitis in one, Mycoplasma pneumonia in one, scarlet fever in two and enteritis in two. The drug was rated "excellent" in eight cases and "good" in four. 2. Eleven strains were isolated from patients: five strains of Streptococcus pyogenes, four strains of Haemophilus influenzae, and two strains of Haemophilus parainfluenzae. Isolated bacteria were eradicated in eight strains and persisting in one, resulting in 88.9% in eradication rate. No follow-up examinations in post-treatment were performed in two cases. 3. No adverse reaction was reported, while one case of eosinophilia was noted as an abnormal laboratory test value. 4. As far as compliance is concerned, patients claimed that the formulation of the drug is "easy to take" or "ordinary". With the results presented as above, we have concluded that AZM is a useful antibiotic in pediatric patients with bacterial infections.

[Mediastinal thoracic duct cyst--a case report]

The patient, a 55-year-old asymptomatic man, was referred to our hospital in October 1995 for further investigation of a chest ++roentogenographic abnormality found during a "physical check-up". His chest X-ray showed a round shadow over the hilus of the left lung. Computed tomography revealed a homogeneous, low density mass bordering the esophagus, vertebral column, left lower pulmonary vein and descending aorta. Roentogenography after swallowing barium sulfate showed that the esophagus was compressed and displaced to the right in the anterior direction. Endoscopic ultrasound scan demonstrated a cystic mass. The preoperative findings were suggestive of an esophageal cyst or a thoracic duct cyst. On December 12, 1995, the patient was operated on. The mass was 2 x 3 x 6 cm in size, and was easily separated from the left pulmonary vein, esophagus and vertebral column by blunt and sharp dissection, but it was strongly adhered to the aorta. The wall of the cyst was incised and a chylous fluid was found inside. The mass was diagnosed as a thoracic duct cyst and was removed after clipping and cutting the thoracic duct above and below the cyst. Histopathological features of the wall of the cyst was that the luminal surface was lined by a monolayer of flat endothelium and composed of loose fibrous tissue with scattered bundles of smooth muscle. It differed from that of veins. The postoperative course was uneventful and he was discharged on the 12th postoperative day. Mediastinal thoracic duct cysts are rare and only 25 operated cases have been reported in the literature. We review and discuss these cases.

Eosinophilia in premature infants: correlation with chronic lung disease

We attempted to clarify the possible pathophysiological significance of eosinophilia in bronchopulmonary dysplasia (BPD). The subjects studied were 17 premature infants, i.e. seven with respiratory distress syndrome (RDS) followed by bronchopulmonary dysplasia (the BPD group: four with stage IV and three with stage III BPD) and 10 infants without BPD (the non-BPD group), who comprised seven with RDS, two with meconium aspiration syndrome and one with transient tachypnea of the newborn. Peripheral eosinophil counts, the number of nuclei of eosinophils and serum eosinophilic cationic protein (ECP) levels, and ECP and polymorphonuclear leukocyte (PMN) elastase levels of intratracheal aspirates (TA) were determined once a week during the first 4 weeks of life. Peripheral eosinophil counts were higher in infants with BPD than those in the non-BPD group. Hypersegmented nuclei of peripheral eosinophils with more than four nuclei were more frequently present in the infants with BPD. A good correlation was observed between peripheral eosinophil counts and serum ECP levels. ECP levels of the TA in the infants with BPD were significantly elevated. There was a good correlation between ECP and PMN elastase levels of the TA. Lung tissue specimens of two infants of the BPD group, both of whom had patent ductus arteriosus (PDA), were obtained from the lower portion of the left lung when they underwent an operative procedure for PDA at 24 and 25 days of life, respectively. Immunohistochemical staining of eosinophil-derived granular major basic protein (MBP) was performed on the lung tissue specimens. Infiltration of a few MBP-staining eosinophils was observed on the specimens from both infants. Our results suggest that peripheral eosinophils in sick premature infants may be activated and appear to be correlated with the severity of BPD. Further studies will be needed to more clarify the physiological role of eosinophils in premature infants.

Effect of overtime work on 24-hour ambulatory blood pressure

Recently, the adverse effects of long working hours on the cardiovascular systems of workers in Japan, including "Karoshi" (death from overwork), have been the focus of social concern. However, conventional methods of health checkups are often unable to detect the early signs of such adverse effects. To evaluate the influence of overtime work on the cardiovascular system, we compared 24-hour blood pressure measurements among several groups of male white-collar workers. As a result, for those with normal blood pressure and those with mild hypertension, the 24-hour average blood pressure of the overtime groups was higher than that of the control groups; for those who periodically did overtime work, the 24-hour average blood pressure and heart rate during the busy period increased. These results indicate that the burden on the cardiovascular system of white-collar workers increases with overtime work.

Effect of pulverization on dehydration behavior of crystals of GK-128, a serotonin3 receptor antagonist

The effect of pulverization on the dehydration behavior of 2-[(2-methylimidazol-1-yl)methyl]benzo[i]thiochromen-1-one monohydrochloride hemihydrate (GK-128), a newly developed serotonin3 receptor antagonist, was studied using powder X-ray diffraction analysis, thermogravimetry (TG), and differential scanning calorimetry (DSC). The crystalline forms of GK-128 obtained by pulverizing with a jet mill and an agale mortar were each confirmed to be the same as that of intact GK-128, since the powder X-ray diffraction patterns of the two prepared samples were identical with that of intact GK-128. However, after pulverization by jet mill, the dehydration temperature of GK-128 was markedly lowered and the DSC endothermic peak due to dehydration disappeared. The activation energy for dehydration, calculated by the Ozawa method using TG data, decreased with decreasing particle size and/or crystallinity of GK-128 crystals, e.g., the activation energies for dehydration of intact and jet-milled GK-128 were 128.1 and 75.9 kj/mol, respectively. The results of comparison of powder X-ray diffraction patterns of pulverized GK-128 and intact GK-128 and of determination of the crystal structure of GK-128 suggested that water molecules could be removed easily along the c-axis of GK-128 crystals.