Genotype-phenotype correlation for extracolonic aggressive phenotypes in patients with familial adenomatous polyposis

Familial adenomatous polyposis (FAP) patients develop various life-threatening extracolonic comorbidities that appear individually or within a family. This diversity can be explained by the localization of the adenomatous polyposis coli (APC) variant, but few reports provide definitive findings about genotype-phenotype correlations. Therefore, we investigated FAP patients and the association between the severe phenotypes and APC variants. Of 247 FAP patients, 126 patients from 85 families identified to have APC germline variant sites were extracted. These sites were divided into six groups (Regions A to F), and the frequency of severe comorbidities was compared among the patient phenotypes. Of the 126 patients, the proportions of patients with desmoid tumor stage ≥III, number of FGPs ≥1000, multiple gastric neoplasms, gastric neoplasm with high-grade dysplasia, and Spigelman stage ≥III were 3%, 16%, 21%, 12%, and 41%, respectively, while the corresponding rates were 30%, 50%, 70%, 50%, and 80% in patients with Region E (codons 1398-1580) variants. These latter rates were significantly higher than those for patients with variants in other regions. Moreover, the proportion of patients with all three indicators (desmoid tumor stage ≥III, number of FGPs ≥1000, and Spigelman stage ≥III) was 20% for those with variants in Region E and 0% for those with variants in other regions. Variants in Region E indicate aggressive phenotypes, and more intensive management is required.

Partial nephrectomy for a Bosniak IV cystic renal mass mimicking a simple renal cyst adjacent to a solid renal tumor

INTRODUCTION

Renal tumors are often associated with renal cysts. Meanwhile, in some cases there are challenging issues of how to diagnose renal cystic tumors and to decide surgical procedures.

CASE PRESENTATION

A 75-year-old man was referred to our department for a 21-mm tumor by his left kidney. Contrast-enhanced computed tomography showed an intense contrast uptake the tumor, which was adjacent to a 64-mm unilocular renal cyst with no contrasting effects. It was clinically diagnosed as renal cell carcinoma, stage T1aN0M0, and treated with robot-assisted partial nephrectomy, for both the solid tumor and the adjacent cyst. Pathological findings revealed a tumor cell clump within the cyst wall, concurrent with the renal cell carcinoma. The patient has remained free of disease at 1 year after surgery.

CONCLUSION

A partial nephrectomy that includes the entire cyst wall should be considered for renal tumor associated with unilocular renal cyst.

Assessment of the safety and efficacy of percutaneous cryoablation for lung tumors

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Background: Percutaneous cryoablation using high resolution fluoroscopic CT guidance under local anesthesia offers a potential tool for local control of lung tumors in combination with systemic treatments. In this study, we retrospectively analyzed the safety, and efficacy of percutaneous cryoablation for lung tumors (PCLT). Methods: This study was approved by the institutional review board. From October 2002, PCLT was performed in patients who either did not oncologically fulfill the indications for resection, or refused resection. CT scan was examined every 3 months after PCLT. >20% increase in the treated lesion size was diagnosed as local failure. Survival analysis was done by Kaplan-Meier. Results: There were 147 patients (95 male, 52 female, mean age 60, 20 primary lung cancer, metastases; 29 of lung cancer, 35 of colorectal cancer, 63 of other sites). 251 sessions were done for 462 tumors. Mean tumor diameter was 18.3mm. PCLT was well tolerated in most patients. In 1 case, broncho-thoracic fistula occurred in the treated region which lead to empyema. Other complications were pneumothorax (153 sessions, 61%, chest tube required in 23 sessions), pleural effusion (160 sessions, 64%), and transient hemoptysis (82 sessions, 33%). Overall one- and two-year local control rates were 81.0% and 59.1%, respectively. Overall one- and two-year survival rates were 80.0% and 54.5%, respectively. In the 1–20 mm sized (n=362) vs. over 21mm sized (n=100) lesions, the local control rates at one year were 84% vs. 56% (p=0.0007), and at two years were 63% vs. 35% (p=0.017), respectively. There were no differences in local control between primary and metastatic tumors, carcinomas and sarcomas. Survival of patients whose lesions were limited to 1–20mm (n=89) was prolonged vs. those who had at least one over 21mm lesion (n=58) (p=0.01). However, one, and two-year survival rates did not differ significantly between these groups (one-year; 85.5% vs. 71.7% (p=0.07), two-year; 60.7% vs. 46.5% (p=0.16)). Conclusions: PCLT was minimally invasive and safe. 1–20mm tumors were good candidates. Contribution of PCLT to survival was not clear in this mixed patient population. To improve local control in over 20 mm tumors, we are computer simulating freezing kinetics to optimize the number and the positioning of the probes.

No significant financial relationships to disclose.

Dietary taurine intake and serum taurine levels of women on Jeju Island

The purpose of this study was to investigate the dietary taurine intake and serum taurine levels of women on Jeju Island in Korea. Sixty six married women aged 43.5 +/- 7.1 volunteered for this study: 34 from the city area and 32 from two fishing-farming areas. Diet samples were collected from the participants; the samples included three meals (breakfast, lunch and supper), including snacks, drinks and whatever else the participants had eaten for 24 hours. Taurine levels in the diet and serum were determined as the dabsyl derivative by HPLC with a Rf-detector. The intake of taurine ranged from 8.4 to 767.6 mg/day and its mean value was 163.9 +/- 150.2 mg/day (mean +/- SD). There was a significant difference between the two groups: 114.9 +/- 78.7 for the women from the city area and 215.9 +/- 187.9 mg/day for the women from the fishing-farming areas (p<0.001). The taurine intake of the total diet, including all snacks and drinks, was 2300 +/- 584 g/day for the city area and 2342 +/- 528 g/day for the fishing-farming areas. The daily protein intake was 58.8 +/- 16.4 g for the women of the city area and 65.5 +/- 17.1 g for the women of the fishing-farming areas. There was a significant correlation between the intake of fish/shellfish and taurine (p=0.001) while there was no correlation between the intake of protein and taurine (p=0.057). The taurine levels in serum ranged from 68.6 to 261.6 micromol/L and the mean value was 169.7 +/- 41.5 micromol/L. There was no significant difference between the women from the city area and the women from the fishing-farming areas in serum taurine levels. The correlations of serum taurine levels with serum retinol levels (p=0.016) and alpha-tocopherol (p=0.014) levels were significant. These results suggest that taurine intake is dependent on the fish/shellfish intake and that taurine may play an important role in the retention of antioxidative nutrients.

[Hypermethylation of DAP-kinase gene CpG Island in malignant lymphoma with B-cell phenotype]

Death-associated protein-kinase(DAP-Kinase) is a pro-apoptotic serine/threonine kinase with a death domain, which is involved in apoptosis induced by interferon-gamma, tumor necrosis factor-alpha, and Fas ligand. Epigenetic down-regulation of DAP-Kinase gene expression by hypermethylation of its promoter region was reported in certain kinds of malignancies. Previous patho-epidemiological studies indicated that thyroid lymphoma(TL) evolves among active lymphoid cells in chronic lymphocytic thyroiditis(CLTH). With the use of methylation specific polymerase chain reaction, methylation status of DAP-Kinase CpG island was examined in thyroid lesions of 19 cases with TL and 9 with CLTH. Frequency of methylation was higher in TL cases(16 of 19, 84.2%) than in CLTH cases(2 of 9, 22.2%) (p < 0.01). DNA extracted from peripheral blood leukocytes from TL and CLTH cases never showed methylation, indicating that the methylation occurred somatically in lesional lymphocytes in the thyroid. We also examined the methylation status of DAP-kinase gene in 16 cases of T-cell malignancies including eight adult T-cell leukemia/lymphoma and 24 NK/T-cell, 34 B-cell, and two immunophenotypically undetermined lymphomas. Frequency of methylation was higher in B-cell(27 of 34, 79.4%) than in T-cell malignancies(eight of 16, 50%) (p < 0.05). Fifteen of 24(62.5%) NK/T-cell lymphomas showed DNA methylation. Hematopoietic cell lines with a methylated gene were resistant to apoptosis. Treatment of the cells with a demethylating agent restored apoptotic cell death in one B-cell lymphoma cell line with DNA methylation. Our results suggested that suppression of DAP-Kinase expression by DNA methylation might play a role in the development of B-cell malignancies.

DNA sequence of immunoglobulin heavy chain variable region gene in thyroid lymphoma

Patho-epidemiological studies have shown that thyroid lymphoma (TL) develops in thyroid affected by chronic lymphocytic thyroiditis (CLTH). CLTH is categorized as an organ-specific autoimmune disease, in which activated B-lymphocytes secrete a number of autoantibodies. Because antigenic stimulation might be involved in the pathogenesis of TL, the variable region in heavy chain (V(H)) genes was characterized in 13 cases with TL and 3 with CLTH. Clonal rearrangement of the V(H) gene was found in 11 cases of TL, and cloning study with sequencing of complimentary determining region (CDR) 3 revealed the presence of a major clone in 4. Three of the 4 cases used V(H) 3 gene, with the homologous germline gene of V3-30 in two cases and VH26 in one case. A biased usage of V(H) 3 and V(H) 4 genes with the homologous germline gene of VH26 in V(H) 3 gene was reported previously in cases with CLTH. A high level of somatic mutation (1-21%, average 12%) with non-random distribution of replacement and silent mutations was accumulated in all cases. The frequency of the occurrence of minor clones ranged from 29-44% per case, indicating the presence of on-going mutation. DNA sequencing of immunoglobulin V(H) gene suggests that TL develops among activated lymphoid cells in CLTH at the germinal center stage under antigen selection.

D-Aspartate is stored in secretory granules and released through a Ca(2+)-dependent pathway in a subset of rat pheochromocytoma PC12 cells

D-Aspartate in mammalian neuronal and neuroendocrine cells is suggested to play a regulatory role(s) in the neuroendocrine function. Although D-aspartate is known to be released from neuroendocrine cells, the mechanism underlying the release is less understood. Rat pheochromocytoma PC12 cells contain an appreciable amount of D-aspartate (257 +/- 31 pmol/10(7) cells). Indirect immunofluorescence microscopy with specific antibodies against d-aspartate indicated that the amino acid is present within a particulate structure, which is co-localized with dopamine and chromogranin A, markers for secretory granules, but not with synaptophysin, a marker for synaptic-like microvesicles. After sucrose density gradient centrifugation of the postnuclear particulate fraction, about 80% of the d-aspartate was recovered in the secretory granule fraction. Upon the addition of KCl, an appreciable amount of D-aspartate (about 40 pmol/10(7) cells at 10 min) was released from cultured cells on incubation in the presence of Ca(2+) in the medium. The addition of also triggered d-aspartate release. Botulinum neurotoxin type E inhibited about 40% of KCl- and Ca(2+)-dependent d-aspartate release followed by specific cleavage of 25-kDa synaptosomal-associated protein. alpha-Latrotoxin increased the intracellular [Ca(2+)] and caused the Ca(2+)-dependent d-aspartate release. Bafilomycin A1 dissipated the intracellular acidic regions and inhibited 40% of the Ca(2+)-dependent D-aspartate release. These properties are similar to those of the exocytosis of dopamine. Furthermore, digitonin-permeabilized cells took up radiolabeled d-aspartate depending on MgATP, which is sensitive to bafilomycin A1 or 3,5-di-tert-butyl-4-hydroxybenzylidene-malononitrile. Taken together, these results strongly suggest that d-aspartate is stored in secretory granules and then secreted through a Ca(2+)-dependent exocytotic mechanism. Exocytosis of D-aspartate further supports the role(s) of D-aspartate as a chemical transmitter in neuroendocrine cells.

Ca2+-dependent exocytosis of L-glutamate by alphaTC6, clonal mouse pancreatic alpha-cells

Pancreatic islet cells express receptors and transporters for L-glutamate and are thus believed to use L-glutamate as an intercellular signaling molecule. However, the mechanism by which L-glutamate appears in the islets is unknown. In the present study, we investigated whether L-glutamate is secreted through exocytosis by alphaTC6 cells (clonal mouse pancreatic alpha-cells). An appreciable amount of L-glutamate was released from cultured cells after the addition of KCl or A23187 in the presence of Ca2+ and 10 mmol/l glucose in the medium. The KCl-induced glutamate release was significantly reduced when assayed in the absence of Ca2+ or when the cells were pretreated with EGTA-AM. The KCl-induced Ca2+-dependent glutamate release was inhibited approximately 40% by voltage-gated Ca2+ channel blockers, such as nifedipine at 20 micromol/l. The degree of KCl-induced Ca2+-dependent glutamate release was correlated with an increase in intracellular [Ca2+], as monitored by fura-2 fluorescence. Botulinum neurotoxin type E inhibited 55% of the KCl-induced Ca2+-dependent glutamate release, followed by specific cleavage of 25 kDa synaptosomal-associated protein. Furthermore, bafilomycin A1, a specific inhibitor of vacuolar H+-ATPase, inhibited 40% of the KCl-induced Ca2+-dependent glutamate release. Immunoelectronmicroscopy with antibodies against synaptophysin, a marker for neuronal synaptic vesicles and endocrine synaptic-like microvesicles, revealed a large number of synaptophysin-positive clear vesicles in cells. Digitonin-permeabilized cells took up L-glutamate only in the presence of MgATP, which is sensitive to bafilomycin A1 or 3,5-di-tert-butyl-4-hydroxybenzylidene-malononitrile (a proton conductor) but insensitive to either oligomycin or vanadate. From these results, it was concluded that alphaTC6 cells accumulate L-glutamate in the synaptophysin-containing vesicles in an ATP-dependent manner and secrete it through a Ca2+-dependent exocytic mechanism. The Ca2+-dependent glutamate release was also triggered when cells were transferred in the medium containing 1 mmol/l glucose, suggesting that low glucose treatment stimulates the release of glutamate. Our results are consistent with the idea that L-glutamate is secreted by alpha-cells through Ca2+-dependent regulated exocytosis.

[Angiographic findings of hemodialysis access insufficiency]

One hundred forty-six angiographic findings of malfunctioning internal arteriovenous fistulas without any history of interventional procedures were reviewed. Angiographies demonstrated 110 cases of stenosis, 72 of occlusion, 5 of venous varicosity, and 13 of venous aneurysm. Of 182 stenotic lesions, 118 (65%) lesions (74 venous stenoses: 67%; 44 venous occlusions: 61%) were revealed within five centimeters of anastomoses. In 4 of 5 cases of varicosity, proximal venous occlusions were demonstrated. On the other hand, interventional procedures were performed in 81 cases of stenoses and 14 of occlusions in the manner of PTA and fibrinolysis. The initial success rate was 90% in stenotic lesions and 71% in occlusive lesions, not a statistically significant difference. Furthermore, there was no statistically significant difference in initial success rates according to anatomical location and lesion length. Although there was no statistically significant difference according to the angiographic findings of lesions, we would like to emphasize the importance of correct understanding of anatomical changes in the dialysis shunt and of early intervention to improve the initial success rate of PTA.

Characteristics of cutaneous lymphomas in Osaka, Japan (1988-1999) based on the European Organization for Research and Treatment of Cancer classification

Based on accumulating information, European investigators proposed a new classification for primary cutaneous lymphomas known as the European Organization for Research and Treatment of Cancer (EORTC) classification. The clinical utility of this classification in Japanese cases has not been evaluated. Material from 65 patients with cutaneous lymphomas (48 with primary disease and 17 with secondary disease) who were admitted to Osaka University Hospital during the period 1988 through 1999 was reviewed. Immunohistochemical analysis was performed in all cases. Cutaneous T-cell lymphoma (CTCL) comprised mycosis fungoides (15 cases), Sézary syndrome (1 case), lymphomatoid papulosis (5 cases), large cell CTCL (13 cases), pleomorphic small- or medium-sized CTCL (2 cases), and cutaneous natural killer /T-cell lymphoma (4 cases). B-cell lymphomas comprised 7 cases of follicle center cell lymphoma and 1 case of diffuse large B-cell lymphoma of the leg. Each category of disease in the EORTC scheme showed its characteristic features in our series. Five of 13 large cell CTCL cases were positive for CD30, and 5 were negative. The 5-year survival rate of patients with large cell CTCL CD30+ disease was 100% and that of patients with CD30- disease was 0%. (p > 0.1). Only 1 of 7 CTCL cases expressing CD30 was ALK-1+, and all 7 cases showed a favorable clinical course. The EORTC classification is effective in dealing with Japanese cases of cutaneous lymphomas.

Sequences of cytotoxic T-lymphocyte epitopes in the Epstein-Barr virus (EBV) nuclear antigen-3B gene in a Japanese population with or without EBV-positive lymphoid malignancies

Latent infection antigens of EBV, including EBV nuclear antigens (EBNAs) and latent membrane proteins, are expressed in latently infected and immortalized B cells but work as target antigens for host cytotoxic T-lymphocyte (CTL) responses in an HLA class I-restricted manner. Among these latent antigens, the immunodominant CTL epitopes in EBNA3B (EBNA3B 399-408 and EBNA3B 416-424) are well characterized. Mutations and strain differences in these sequences, compared to the prototype A sequence, reduce CTL responses to latently infected B cells. These EBNA3B CTL epitopes in the normal Japanese population and in 2 lymphoid neoplasias, pyothorax-associated lymphoma (PAL) and nasal natural killer-cell lymphoma, were directly sequenced by PCR. Most EBV in peripheral blood leukocytes (PBLs) from healthy Japanese donors exhibited the prototype A sequence, with mutations in approximately 20% (3/16). The sequence of EBNA3B CTL epitopes in lymphoma tissue was obtained in 6 PAL cases, and 5 exhibited mutations or strain differences compared to the prototype A sequence. Furthermore, the EBNA3B sequence in PAL tissue was different from that in PBLs of the same patient or 1 of the sequences found in PBLs. However, the EBNA3B gene in nasal lymphoma tissues exhibited predominantly the prototype A sequence. Because PAL cells expressed EBNA3B mRNA, detected by RT-PCR, but nasal lymphoma cells did not, mutations and strain differences of the sequences of EBNA3B CTL epitopes were specific findings in EBNA3B-positive lymphomas.

Role of hypermethylation of DAP-kinase CpG island in the development of thyroid lymphoma

Death-associated protein-kinase (DAP-Kinase) is a serine/threonine kinase with a death domain that is involved in apoptosis induced by interferon-gamma, TNF-alpha, and Fas ligand. Epigenetic down-regulation of DAP-Kinase gene expression by hypermethylation of its promoter region was reported in B-cell malignancies. Previous pathoepidemiologic studies indicated that thyroid lymphoma (TL) evolves among active lymphoid cells in chronic lymphocytic thyroiditis (CLTH). With use of methylation-specific polymerase chain reaction, the methylation status of DAP-Kinase CpG island was examined in thyroid lesions of 19 cases with TL and 9 with CLTH. The frequency of methylation was higher in TL cases (16 of 19, 84.2%) than in CLTH cases (2 of 9, 22.2%) (p < 0.01). DNA extracted from peripheral blood leukocytes from TL and CLTH cases never showed methylation, indicating that the methylation occurred somatically in the lesional lymphocytes in thyroid. These findings suggested that methylation of the DAP-Kinase promoter region might be involved in the development of TL from CLTH.

Low frequency of HLA-A*0201 allele in patients with Epstein-Barr virus-positive nasal lymphomas with polymorphic reticulosis morphology

Lymphoproliferative diseases of the nasal cavity and paranasal sinuses occur frequently in Asian countries and are histologically categorized as monomorphic ordinary lymphoma and polymorphic reticulosis (PR) with apparent inflammatory cell infiltration. The large atypical cells in PR show natural-killer cell nature and frequently contain Epstein-Barr virus (EBV) DNA. Among the EBV genes involved in latent infection, those encoding EBV latent membrane proteins are frequently expressed in PR. Several cytotoxic T-lymphocyte (CTL) defined epitopes have been mapped to latent membrane proteins restricted with HLA-A2, -A11 or -A24 antigens. Thus, the HLA-A allele may affect the development of PR. To examine this possibility, HLA-A alleles of 25 patients with EBV(+) PR were determined with low-resolution polymerase chain reaction-based typing using HLA-A locus sequence-specific primer combinations. The frequency of HLA-A alleles including HLA-A2 and -A24 antigens in PR patients was lower than that in the normal Japanese population, but the difference was not significant. Since HLA-A2-restricted CTL responses are well delineated at the A2-subtype level, the A2-subtype of PR cases with HLA-A2 antigen was further determined by high-resolution genetic typing. The frequency of HLA-A*0201 in PR was significantly lower than in the normal population (p=0.0314). The HLA-A*0201-restricted CTL responses may thus function in vivo to suppress the development of overt lymphoma.

(+)-catechin acts as an infection-inhibiting factor in strawberry leaf

ABSTRACT An infection-inhibiting factor (IIF) was isolated from strawberry leaves and identified as (+)-catechin. This compound inhibited the formation of infection hyphae from appressoria of Alternaria alternata, but allowed both spore germination and appressorial formation. It is a normal component of strawberry leaves, but further accumulates as the major IIF in response to inoculation with nonpathogenic spores of A. alternata. The accumulation of (+)-catechin on a susceptible host was not induced, however, by inoculation with pathogenic spores of the strawberry pathotype or by inoculation with nonpathogenic spores supplemented with host-specific toxin (AF-toxin I). These results imply that (+)-catechin acts as a protective agent during induced resistance and that AF-toxin I acts as a fungal suppressor of induced resistance.

[Metallic stent placement for iliac artery occlusive disease]

Since 1991, we have performed stent placement for 35 iliac artery lesions in 31 patients. The etiologic diseases were atherosclerotic in 34 patients and traumatic dissection in one. The indications of placement were total occlusion in 3, late restenosis after angioplasty in 5, dissection in 5, and residual stenosis due to inadequate angioplasty in 21. We also performed direct stent placement for one traumatic dissection. The stents used were Wallstents in 10, Palmaz stents in 14, Strecker stents in 9, and Memotherm stents in 2 lesions. Follow-up was performed clinically or angiographically with measurement of the ankle/arm pressure index. Stent placement was successful in all cases, and relief or improvement of symptoms was achieved. The follow-up period ranged from 6-85 months (mean, 37.3 months). Late stent stenosis or occlusion occurred in 6 cases, among which 4 occluded lesions were successfully recanalized by thrombolytic therapy with angioplasty or second stent placement. In total, the primary patency rates were 88% and 77% at two and four years, respectively, while the secondary patency rates were 94% and 94%. In conclusion, metallic stent placement may offer extended application of intravascular treatment for iliac artery occlusive disease, and good long-term patency rates can be expected.

Analysis of T-cell antigen receptor gamma chain gene rearrangement by polymerase chain reaction in combination with denaturing gradient gel electrophoresis in the differential diagnosis of cutaneous T-lymphoproliferative diseases

A polymerase chain reaction (PCR)-based strategy has been developed for analysis of clonal rearrangement of the T-cell receptor gamma gene (TCR gamma) and was shown to be useful for detection of clonal T-cell populations. In this study, we performed PCR combined with denaturing gradient gel electrophoresis (DGGE) on fresh frozen biopsy samples from 16 patients with cutaneous T-lymphoproliferative diseases in whom a definite diagnosis was difficult to make on morphological and immunohistochemical grounds alone. Ages of the patients at biopsy ranged from 28 to 81 (median 62) years, and the subjects consisted of 8 men and 8 women. They presented with erythema on the extremities in 5 cases, trunk in 7, buttock in 2, and papules on the trunk and face in one case each. Clonal rearrangement of TCR gamma was observed in 3 of 16 cases. Clinical diagnoses of these three cases were mycosis fungoides, cutaneous invasion of adult T-cell leukemia (ATL), and large granular lymphocytic leukemia (LGL) of T-cell type, respectively, but they were histologically difficult to differentiate from reactive cutaneous T-cell proliferation. The skin lesions of the LGL case worsened, and this patient died two years after biopsy. Another patient with suspected mycosis fungoides in the plaque stage died due to dissemination of tumors 22 months after biopsy. The remaining one patient with ATL survived with cutaneous lesions for over four years. Clonality was not demonstrated in the remaining 13 cases, and their clinical courses were favorable. These findings showed that demonstration of clonal TCR gamma gene rearrangement using the PCR-DGGE method is very helpful for diagnosis of cutaneous T-cell neoplasms.

Mutations of the p53 gene in nasal NK/T-cell lymphoma

Mutations of the p53 tumor suppressor gene are reported in various kinds of malignancies including lymphomas. However, p53 gene mutations in nasal NK/T-cell lymphoma have not been reported because most parts of tumors are necrotic and a small amount of living tumor tissues is available for the molecular study. Expression and mutations of the p53 gene were examined in the paraffin-embedded specimens of the nasal lesions from 42 Chinese (Beijing and Chengdu) and Japanese (Okinawa and Osaka) patients with nasal NK/T-cell lymphoma by the immunohistochemistry and single strand conformation polymorphism (SSCP) analysis of polymerase chain reaction (PCR) amplified products followed by direct sequencing. Thirty single-nucleotide substitution mutations were observed in 20 of 42 cases (47.6%). Among the 30 mutations, 18 were missense (mainly G:C to A:T transitions), 9 were silent, and 1 was a nonsense mutation. The remaining 2 mutations involved intron 5 and exon 5 terminal points. Abnormal expression of the p53 protein was also observed in 19 of 42 (45.2%) cases. The incidence was significantly (4-fold) higher in the cases of Osaka than those in other areas, although the incidence of p53 mutations in the cases of Osaka was one-half to one-third of those in the other three areas. The results may suggest some racial, environmental, or lifestyle differences in the cause of nasal tumorigenesis.

[Contrast medium injection on CT during hepatic arteriography: comparison of two protocols]

To assess the optimum method of contrast medium injection on CT during hepatic arteriography (CTHA), we performed this procedure in 37 patients using two consecutive protocols (A and B) employing different concentrations of iodine (iohexol at 140 mgI/ml and 300-350 mgI/ml), flow rates (2 ml/sec and 1 ml/sec), and contrast medium volumes (60 ml and 30 ml). Mean parenchymal enhancement of the right lobe and left lateral segment were measured and compared. Enhancement varied significantly more with protocol B, especially in the left lateral segment. These results suggest that a low iodine concentration and high injection rate are suitable for CTHA, to avoid nonuniform parenchymal enhancement.

Immunophenotypic and genotypic characterization of nasal lymphoma with polymorphic reticulosis morphology

Nasal lymphoma with polymorphic reticulosis (PR) morphology is now categorized as T/natural killer (T/NK) cell lymphoma. In this study, immunophenotypes and genotypes of proliferating cells in 21 cases with PR were examined. The patients included 13 men and 8 women ranging in age from 20 to 74 (median 37) years. All patients presented with lesions in the upper respiratory tract, mostly in the nasal cavity. Histological specimens obtained from the primary lesions (19 cases) and metastatic cervical lymph nodes (2 cases) were used for analyses. Histologically, polymorphous proliferation was found in 20 cases, and these were thus diagnosed as PR. A monomorphous pattern was found in the remaining last case. Immunohistochemical analysis revealed that the proliferating cells were CD56 (123C3)+ and/or CD16 (2H7)+, TIA-1+ and frequently stained CD3 epsilon+. Tumor cells were frequently stained positively with monoclonal antibodies (mAbs) for T lymphocytes, but were negative for T-cell receptor (TCR) beta and delta chain expression. In situ hybridization analysis using an Epstein-Barr virus-encoded early RNA 1 (EBER-1) probe revealed positive signals in 13 of the 15 cases examined. Southern blotting analysis for clonality of the Epstein-Barr virus (EBV) genome in 12 positive cases confirmed the presence of monoclonal proliferation in 7 cases. The pattern of TCR gamma chain gene rearrangement was examined by PCR analysis of DNA from tumor tissues by the denaturing gradient gel electrophoresis method. The results demonstrated no clonal rearrangement in any of the 21 cases examined, including 7 cases with proven clonal proliferation of EBV-infected cells, indicating the absence of T-cell clones. Our findings strongly suggested that nasal T-cell lymphoma is in fact a NK cell lymphoma.

[Prediction about daily scattering count of Japanese cedar pollen]

We investigated the relationship between the daily count of pollen scattered, the count of days during the scattering period and the highest temperature during the sugi (Japanese cedar) pollen scattering season from 1983 to 1997, and whether prediction of the count of pollen scattered for the following day is possible. Our studies clearly demonstrated that the count of sugi pollen scattered is small in the early period of the scattering season with some daily variations in amount; this cycle is repeated for several days in the middle period of the season then decreases again in the late period. These findings showed that both the cumulative value of the count of pollen scattered daily and the total count of pollen scattered formed an S-shaped curve when compared with the count of days after the start of the scattering season and the cumulative highest temperature for the season. Predicting the daily count of pollen scattered after the start of the scattering season against the cumulative highest temperature is possible by drawing a regression curve from the S-shaped curve. Also, a regression curve was useful in predicting the total count of pollen scattered during the season from the cumulative count of pollen scattered 10 to 20 days after the start of the scattering season. Using these data, we were able to improve the accuracy for predicting the scattering of sugi pollen.

Midfacial degloving approach facilitated by endoscope to the sinonasal malignancy

Midfacial degloving is known to provide excellent exposure of the central compartment of the anterior and middle cranial fossae without facial incisions. In this study, an endoscope was adapted for midfacial degloving technique in the medial maxillectomy with ethmoidectomy in five patients with sinonasal malignancy. Meticulous and safe manipulation in the medial and inferior aspect of the orbit, sphenoid sinus and olfactory fossa can be obtained by endoscopic management without serious complications. This procedure, employing an endoscope, offers accurate and safe resection of selected cases with the sinonasal malignancy.

Appearance of a different clone of Epstein-Barr virus genome in recurrent tumor of pyothorax-associated lymphoma (PAL) and a mini-review of PAL

A case of pyothorax-associated lymphoma (PAL) is reported. A 76-year-old Japanese man developed a lymphoma in the pleural cavity after 46 years duration of pyothorax due to pulmonary tuberculosis. The histologic diagnosis of biopsy specimen was diffuse large cell lymphoma of B cell type. The lymphoma cells contained the monoclonal Epstein-Barr virus (EBV) determined by the analysis of terminal repeat of EBV genome and expressed EBV nuclear antigen 2 and latent membrane protein 1 (LMP1). He received antineoplastic chemotherapy and was induced to complete remission (CR). After 19 months of CR, the lymphoma developed again in the thoracic wall. Histopathology and immunohistochemical phenotypes of recurrent tumor were almost the same as those of the primary tumor with the exception of a little more frequent expression of LMP1. The EBV genome in lymphoma cells was monoclonal, however, the clone was different from that of the primary tumor. After antineoplastic chemotherapy, minor EBV-positive clones in primary lymphoma might survive and develop into recurrent tumor. These results suggest that the PAL starts as poly- or oligoclonal proliferation of B lineage cells. This poly- or oligoclonality of PAL at the initial stage may suggest underlying immunosuppressive conditions in the development of PAL.

Site-specific delivery of iloprost during experimental angioplasty suppresses smooth muscle cell proliferation

PURPOSE

The authors have previously reported that intramural delivery of iloprost during angioplasty suppresses local platelet aggregation at 1 hour in undiseased porcine arteries. In this study, the authors sought to quantify the effect of such treatment on medial vascular smooth muscle cell proliferation, an event implicated in the development of intimal hyperplasia.

MATERIALS AND METHODS

Three Yorkshire pigs underwent percutaneous transluminal angioplasty with hydrogel-coated balloons for a total of 10 iloprost-treated (experimental) and 10 saline-treated (control) arterial sites. The balloons were prepared with previously reported techniques and loaded with 2.25 microg of iloprost for the experimental sites. On the eighth day after angioplasty, these sites were harvested and prepared for immunohistochemical staining. Thin (4 microm) sections of the specimens were stained with use of monoclonal antibody to proliferating cell nuclear antigen (PCNA). Appropriate positive and negative controls were used. Approximately 350-500 vascular smooth muscle cells were randomly counted under high power (100x) by an experienced physician who was blinded to the origin of the specimen. A PCNA index (%) was calculated as follows: [(#PCNA [+] cells)/(#PCNA [+] cells + #PCNA [-] cells)]x 100. A paired t test was used for statistical comparison.

RESULTS

The PCNA indices for eight (n = 8) paired large vessels (iliac, carotid, subclavian) were 7.98 (+/- 1.8)%, for the iloprost-treated experimental sites, and 14.58 (+/- 3.8)% for the saline-treated control sites. This difference was statistically significant (P = .003). One large vessel pair was not available for analysis. When the pair of renal arteries of animal 3 were included (n = 9), the PCNA indices were 8.32 (+/- 2.3)% for the experimental sites, and 13.79 (+/- 4.2)% for the control sites. The differences were again significant (P = .01).

CONCLUSION

Intraarterial site-specific delivery of iloprost during angioplasty with drug-loaded, hydrogel-coated balloons significantly suppresses medial smooth muscle cells in swine at the expected peak period of proliferation of 7 days after angioplasty.

A press-through-pack in the larynx

A case of a 96-year-old male with a foreign body in the larynx is reported. The foreign body was a press-through-pack (PTP), a plastic packing for medicine, 16 mm x 16 mm x 3 mm in size. The PTP was safely removed from the larynx under general anesthesia.

Mural delivery of iloprost with use of hydrogel-coated balloon catheters suppresses local platelet aggregation

PURPOSE

To develop reproducible and quantifiable methods for mural delivery of iloprost, a potent agent against platelet aggregation, with use of hydrogel-coated angioplasty balloons, and to determine the in vivo effect of direct iloprost delivery on platelet aggregation at the angioplasty site.

MATERIALS AND METHODS

Drug loading of tritiated iloprost from an immersion solution onto hydrogel-coated balloons was evaluated as a function of balloon size (3 mm x 2 cm, 6 mm x 2 cm, 8 mm x 3 cm; n = 4 each), drug concentration (0.0715 mg/mL, 0.1072 mg/mL, 0.1430 mg/mL; n = 3 each), and duration of immersion (40 seconds, 60 seconds, 120 seconds; n = 3 each). In another set of experiments, optimal drying methods were tested to minimize drug loss within a protective delivery sheath (n = 3 each). Ex vivo angioplasty was performed on excised swine arteries to estimate how much of the drug present on the balloon could be delivered to the wall (n = 3 iliac segments). Finally, in vivo angioplasty was performed in three Yorkshire pigs (n = 6 iloprost-treated and 6 control arteries) and indium-111-labeled platelet aggregation was measured at these sites, which were harvested 1 hour after the procedure.

RESULTS

In the initial set of experiments, the authors found that the volume of drug loaded is determined by the wet-volume of the hydrogel coating, that the majority of volume loading occurs within the first 2 minutes, and that the volume uptake is independent of the drug concentration. The optimal drying method resulting in the least loss of iloprost within the sheath (only 4%) was prolonged drying (5 hours) under ambient conditions. Ex vivo angioplasty experiments showed that approximately 33% of the drug present on the balloon can be delivered to the wall. Finally, in vivo experiments showed that platelet aggregation is significantly suppressed at treated sites (by approximately 33% compared to control sites; P = .03) by minuscule mural doses of iloprost (roughly estimated at under 1 microg).

CONCLUSION

Quantifiable and reproducible methods for loading iloprost onto hydrogel-coated angioplasty balloons were developed. The best of these methods was able to deliver enough iloprost into the wall to significantly reduce local platelet aggregation.

Resolution enhancement printing with a variable spot-size laser diode

We demonstrate enhanced resolution printing using a variable spot-size laser diode. The near-field spot size of the laser diode can be changed by controlling the refractive-index distribution in the laser stripe through the injected current. The ratio of the minimum-to-maximum spot size is 2.1:1. This technology provides high-resolution printing without increasing the scanning frequency. Smoother character outlines that consist of finer steps are produced with this laser diode. An effective resolution of 1200 dots /in. (dpi) can be obtained by a printer system with 600-dpi resolution.

[Immunohistological study of infiltrating cells in nasal mucosa and nasal lavage fluid of perennial allergic rhinitis]

It is well known that EG2-positive cells, CD68-positive cells and other inflammatory cells significantly increase after antigen provocation in the nasal mucosa of an allergic patient. However, there are few reports of the immunohistological study if the infiltrating cells in nasal lavage fluid are not seen. In this study, the infiltrating cells in nasal mucosa as well as in nasal lavage fluid were immunohistologically examined by means of monoclonal antibodies 30 minutes after the antigen provocation. Seven patients with perennial allergic rhinitis were challenged by an antigen disk placed on one side of the inferior turbinates and each nasal cavity was irrigated separately 30 minutes after the antigen provocation. About seven days later, these patients were operated on and the nasal mucosa was removed 30 minutes after the antigen provocation. No marked change in CD4- and CD8 positive cells in the nasal mucosa and lavage fluid was found after provocation. On cytospin glass slides, there was a slight increase in the number of CD68 (P = 0.1), EG2 (P = 0.09), and neutrophil elastase positive (P = 0.2) cells. A significant increase in EG2-positive cells was also seen in the superficial layer of the lamina propria (P < 0.05) but not in the deep layer. CD22 positive cells were not seen on the cytospin glass slide, whereas many positive cells were observed in the deep layer of the lamina propria. These results indicate that EG2-positive cells participate strongly in the early phase of the allergic response after provocation in spite of the absence of significant changes in CD4- and CD8 positive cells. Immunohistological evaluation of nasal lavage is thought to be beneficial concerning the movement of each kind of cells. Each kind of cell is thought to fulfill the main physiological role in the epithelial layer or the lamina propria in early allergic inflammation.

[The effect of initial treatment by FP aqueous nasal spray in patients with Japanese cedar pollinosis]

It is well known that an initial treatment with several kinds of antiallergic medicines is useful for patients suffering from Japanese cedar pollinosis to reduce nasal symptoms during the pollen season. Also topical corticosteroids show a preventive effect as antiallergic medicines. In this study, the preventive effect of topical corticosteroids with antiallergic medicine as an initial treatment was evaluated during the 1995 cedar pollen season a season in which a high pollen count was anticipated. Twenty-five patients with cedar pollinosis were selected and divided into two groups. A and B, A topical corticosteroid (fluticasone propionate; Flunase) as well as antiallergic medicine (azelastin) were administered to patients in group A 4 weeks before the beginning of the pollen season. In group B, only antiallergic medicine was given at the same time as group A and a topical corticosteroid was administered after the appearance of the symptoms. Nasal symptoms and mucosal conditions of the nasal cavity were monitored throughout the pollen season. The inflammatory cells in the mucoepithelial layer of the nasal mucosa were also periodically evaluated by immunohistochemical staining. Nasal symptoms and mucosal conditions in group A were significantly improved compared with patients in group B. The infiltration of macrophages in the mucoepithelial layer of the nasal mucosa was strongly inhibited in group A. The numbers of mast cells and EG2-positive cells in group A were not significantly different from those in group B during the pollen season. According to these results, although not all inflammatory cells were inhibited, the initial treatment with Flunase aqueous nasal spray in addition to the conventional initial treatment with antiallergic medicine is very useful for reducing symptoms even in a season with a large amount of cedar pollen.

[Atherectomy with over-the-wire type catheter for femoro-popliteal artery stenosis: initial and eight month follow-up results]

Percutaneous atherectomy using Atherotrack was performed in 5 patients with symptomatic femoro-popliteal artery stenosis. All patients were men and ages ranged from 37 to 70. Four lesions were atherosclerotic and 1 lesion was post-operative anastomotic stenosis following traumatic popliteal artery injury. There was no technical failure and all lesions were successfully dilated with no or minimal residual stenosis. API returned within normal limit and patients were symptom-free immediately after the procedure. We experienced no major complication related to this procedure. Excised specimen included thickened fibrous intima, atherosclerotic materials, calcification, internal elastic lamina and fibrous media. Follow-up DSA 5 months after procedure showed good patency in 4 cases, and they remained free from symptoms in this follow-up period. In those patients, lesions were generally short and eccentric, run-off was good, and only thickened intimal tissue was obtained. Those factors seem to promise long-term patency and to be good indications of atherectomy. Restenosis as well as recurrence of claudication, however, developed in one patient with DM, who had long, tight, complex stenosis and poor run-off. Considerable amount of medial tissue was found in this specimen. We suspect that those factors were associated with reduced long-term patency rates.

[Blood flow measurement of renal artery branches, in special reference to interlobular artery by color Doppler]

Blood flow measurement was performed in 58 kidneys of healthy persons. Detection rate, maximum flow velocity (Vmax), pulsatility index (PI) and resistive index (RI) were measured at main renal artery, segmental artery, interlobar artery and interlobular artery with 2 D-Doppler ultrasound machines. Detection rate was highest at interlobar artery. Vmax and PI tended to fall down with arterial branching. Interlobular artery was usually not visualized by color flow mapping, but sometimes well visualized using Acuson machines. Additional measurement of interlobar and interlobular arteries were performed in such 15 cases, and the result was essentially equal to the above mentioned study.

[Advantages of intravascular ultrasound--preliminary experience in patients with peripheral and renal vascular disease]

Intravascular ultrasound (IVUS) is a new method in which endovascular images are obtained from a catheter inserted into an artery. We uses IVUS during PTA of iliac and renal artery, and examined its effectiveness. Three layers are well defined in normal arterial wall. Calcified deposits are recognized as a combination of strong echo and acoustic shadow. The absolute cross sectional area of patent lumen and atherosclerotic plaque can be calculated. IVUS is very effective for the assessment of PTA. The increased caliber of arteries following PTA is caused by the over stretching of the media rather than the compression of atheroma.