[Changes in gadolinium-DTPA enhanced magnetic resonance signal intensity ratio in hypertrophic cardiomyopathy]

Serial gadolinium-diethylene-triamine-pentaacetic acid (Gd-DTPA) enhanced magnetic resonance (MR) signal intensity ratios were measured in 6 normal subjects and 20 hypertrophic cardiomyopathy (HCM) patients to try to differentiate normal from disorganized myocardial tissue. Images were obtained at 10-minute intervals 5-60 minutes after Gd-DTPA (0.1 mmol/kg) injection. The signal intensity ratio (myocardial signal intensity/skeletal muscle signal intensity) was measured at both hypertropic and nonhypertrophic regions in each image at the apex and mid-ventricular levels. The signal intensity ratio was standardized to compare each case. Hypertrophic myocardium was classified into two types. Type I in 11 of 20 patients was visualized as a homogeneous image, while type II in the other 9 patients was revealed as a mixed isointensity and high intensity area. The peak value of the standardized signal intensity ratio at the apex level was 1.28 +/- 0.09 in HCM patients and 1.23 +/- 0.06 in normal subjects, and at the mid ventricular level was 1.26 +/- 0.07 in hypertrophic regions, 1.17 +/- 0.12 in non-hypertrophic regions, and 1.16 +/- 0.07 in normal subjects. Thirty minutes after Gd injection, the standardized signal intensity ratio at the apex level was 1.21 +/- 0.08 in HCM patients and 1.07 +/- 0.08 in normal subjects, and those at the mid ventricular level was 1.20 +/- 0.09 in hypertrophic regions, 1.11 +/- 0.11 in non-hypertrophic regions, and 1.04 +/- 0.06 in normal subjects. The delayed decay of the signal intensity ratio and high signal intensity ratio in Gd-DTPA enhanced MR images are useful in myocardial tissue characterization in hypertrophic cardiomyopathy.

Immunotherapy for Stewart-Treves syndrome. Usefulness of intrapleural administration of tumor-infiltrating lymphocytes against massive pleural effusion caused by metastatic angiosarcoma

We describe a 56-year-old woman with Stewart-Treves syndrome who had severe dyspnea from a pleural effusion caused by metastatic angiosarcoma in the right lung. Tumor-infiltrating lymphocytes (TIL) in the pleural effusion were cultured and expanded in vitro in the continuous presence of recombinant interleukin 2 with periodic stimulation by CD3 antibody. The expanded TIL were administered intrapleurally seven times at 1- to 4-week intervals in combination with intravenous infusion of recombinant interleukin 2. A panel of T-cell clones was also obtained from TIL. Immunotherapy dramatically improved the patient's dyspnea and pleural effusion. A CD4+ T-cell clone and a CD8+ T-cell clone established from TIL had specific cytotoxicity to the tumor cells.

[Acanthamoeba isolation from contact lens solution of contact lens wearers without keratitis]

Acanthamoeba keratitis seems to be associated with wearing contact lenses. As controls, we surveyed contact lens wearers without keratitis. Contact lens solutions of 93 persons were examined in order to identify risk factors for contamination by Acanthamoeba. Therefore, the contact lens disinfection system and storage schedules were studied in each case. Acanthamoeba organisms were isolated from 4 specimens (4.3%). The incidence of Acanthamoeba was higher in specimens of soft contact lens solution than in those of hard contact lens solution, and all the Acanthamoeba positive cases had been using tap water.

Elevated chromosome aberration frequency after X-ray exposure of cultured fibroblasts derived from patients with porokeratosis

Porokeratosis (PK) is a rare genetic skin disorder inherited as an autosomal dominant trait and regarded as a disease predisposing to cancer. To evaluate chromosomal radiosensitivity of PK cells, we examined chromosome aberration frequency after X-irradiation of cultured skin fibroblasts derived from PK patients and controls. Without X-ray exposure, frequencies of chromosome-type aberrations (exchanges or deletions) were not different between the patients and controls. Following X-ray irradiation, frequencies of deletions in the patient group were significantly increased, whereas those of exchanges were not elevated. No differences in chromatid-type aberration frequency were found between the patients and controls with or without exposure to X-ray. The observed radiosensitivity, though not as high as in ataxia telangiectasia (AT) cells, agrees well with the previously reported higher radiosensitivity of PK fibroblasts in survival analysis.

Altered expression of NU-T2-BMZ antigen and type VII collagen in basal cell epithelioma

The cutaneous basement membrane zone (BMZ) is composed of a large number of molecular components. We have recently reported that one of the CD1b monoclonal antibodies (MoAb), NU-T2, reacts to the BMZ of the normal human skin, esophagus and stomach. In order to further elucidate the biological properties of the NU-T2-BMZ antigen, we investigated the expression of NU-T2-BMZ antigen and type VII collagen (well identified component of anchoring fibrils) in various skin tumors such as basal cell epithelioma (BCE), squamous cell carcinoma, Bowen's disease, actinic keratosis and seborrheic keratosis. NU-T2 MoAb failed to react to the BMZ in all BCE. Anti-type VII collagen MoAb showed reduced staining of the BMZ in some nests of BCE. Both antigens, however, were preserved in the BMZ of other skin tumors as in the normal adjacent skin. Furthermore, anti-type VII collagen MoAb demonstrated the clear intratumoral staining in all BCE examined. The abnormal expression of NU-T2-BMZ antigen and type VII collagen may partly explain the space formation between the BCE nests and the surrounding stroma frequently observed in histology.

Differential induction of adult and fetal globin gene expression in the human CML cell subline KU-812F/33

Various chemicals which are known to have positive effects on differentiation of some erythroid cell lines were tested on a human chronic myelogenous leukemia cell line, KU-812F. Succinic acid, 5-azacytidine, daunomycin, and hemin showed a positive effect. Among them, hemin and 5-azacytidine were the most effective inducers for erythroid differentiation of KU-812F cells. Dimethylsulfoxide, cytosine arabinofuranoside, and sodium n-butyrate showed no effect. In addition, subclone KU-812F/33 derived from the KU-812F cell line showed differential expression of the beta- and gamma-globin genes in the presence of either 2 microM 5-azacytidine or 40 microM hemin. Hemoglobin synthesis in differentiated KU-812F/33 cells was analyzed by isoelectric focusing gel electrophoresis, and S1 mapping analysis of beta- and gamma-globin mRNA was performed. After treatment with 5-azacytidine, the beta-globin gene expression was predominantly enhanced (18.75-fold higher level of beta-globin mRNA). After treatment with hemin, the most notable increase was in the gamma-globin gene expression (1.83-fold higher level of gamma-globin mRNA), while no increment of beta-globin was observed.

[Late recurrence of renal cell carcinoma: report of three cases]

A 70-year-old woman underwent a left radical nephrectomy. The pathological examination revealed renal cell carcinoma (RCC), grade 1 and no lymph node metastasis. She suffered a recurrence in the renal fossa 11 years after the operation. The doubling time of the recurrent lesion was calculated to be very long for the cancer; about 1.3 years. Another case was in a 61-year-old woman, who underwent a right radical nephrectomy. The pathological examination revealed RCC, grade 1 with vascular invasion and no lymph node metastasis. Eleven years postoperatively she developed metastases in both lungs. The other case was in a 39-year-old woman, who underwent right radical nephrectomy. The pathological examination revealed RCC, grade 1 with vascular invasion and no lymph node metastasis. Eight years postoperatively she developed a recurrence in the left kidney. The doubling time of the recurrent lesion was about 0.9 year. All three patients responded to conservative therapy including interferon. Taking those doubling times into account, the recurrent lesions in the first and third cases seemed to have been growing very slowly and not rapidly immediately before clinically evident recurrence. Patients with a low grade RCC must have life-long followup.

Ultrastructure of the neuromuscular junction of vasomotor nerves in the microvasculature of human dental pulp

Vasomotor nerves in human dental pulp were more closely related to arterioles than to venules. Most were composed of unmyelinated fibres, which were mainly adrenergic. They appeared close to arterioles that were surrounded by a few layers of contractile smooth-muscle cells. The smaller arterioles with a diameter of 10-15 microns received a more intimate innervation by vasomotor nerves than did the larger. These vessels occasionally showed much narrower neuromuscular junctions than previously reported. Most of these nerve fibres were identified as adrenergic by the presence of chromaffin-positive synaptic vesicles detected by ultrastructural enzyme histochemistry. Their function appeared to be to regulate the blood flow and/or the blood pressure by stimulating smooth-muscle cells, resulting in contraction and a change in the calibre of the vessels. Capillaries and venules, which have a higher permeability, received weaker innervation by the vasomotor nerves than did arterioles. The intimate relation between vasomotor nerves and arterioles is related to the function of dental pulp in normal and pathological conditions.

Simultaneous racemization and isomerization at specific aspartic acid residues in alpha B-crystallin from the aged human lens

We provide evidence that the racemization and isomerization of aspartyl(Asp) residues occur simultaneously in the alpha B-crystallin in the lens of aged (mean age: 80 years) and young (age: 11 months) humans. We purified alpha B-crystallin and subjected it to tryptic digestion. The resulting peptides were separated by reverse-phase high-performance chromatography (RP-HPLC) and were characterized by amino-acid composition, sequence analysis and mass spectrometry. Two specific sites, Asp-36 (D/L of Asp: 0.92) and Asp-62(D/L of Asp: 0.57), among 13 Asp/asparginyl (Asn) residues in aged alpha B-crystallin, were found to be highly racemized and isomerized to form beta-Asp residues. The beta-Asp-containing peptides were clearly distinguished from normal Asp-containing (alpha-Asp) peptides by RP-HPLC. The racemization and isomerization of Asp residues in aged alpha B-crystallin may occur via a succinimide intermediate. In young alpha B-crystallin, we observed neither racemization nor isomerization. We also found that Met-68 was oxidized to form Met sulfoxide to a greater extent in aged alpha B-crystallin than in young alpha B-crystallin. We concluded that racemization, isomerization, and oxidation of alpha B-crystallin occur spontaneously in the aging process.

The growth regulation of neurofibroma cells in neurofibromatosis type-1: increased responses to PDGF-BB and TGF-beta 1

In neurofibromatosis type-1 (NF-1), abnormal growth regulation may be related to the formation of multiple neurofibromas. We investigated the growth responses of neurofibroma-derived cells (NF cells) and control skin fibroblasts to various growth factors. The responses to platelet-derived growth factor (PDGF-BB) and transforming growth factor-beta 1 (TGF-beta 1) in NF cells were significantly greater than those in control fibroblasts. The increased response to PDGF-BB in NF cells was accompanied by an increased number of PDGF beta receptors, which was demonstrated by both 125I PDGF-BB binding assay and immunoblotting analysis. The increased response to TGF-beta 1 was assumed to be mediated through PDGF-like protein induction; TGF-beta 1-treated NF cells produced greater amounts of 36-kD PDGF-like protein than TGF-beta 1-treated control fibroblasts. These observations suggest that certain growth factors, e.g., PDGF-BB and TGF-beta, may play some role in the development of neurofibromas in NF-1.

Serum concentration of procollagen type I carboxyterminal propeptide in systemic sclerosis

The serum level of procollagen type I carboxyterminal propeptide (P1CP), which has been used as an index of collagen synthesis in patients with various fibrotic diseases during the active stage, was measured using enzyme-linked immunosorbent assay in 61 patients with systemic sclerosis (SSc) and in 21 control subjects. The mean P1CP level in the SSc patients was significantly higher than in the normal controls (mean +/- SD, 326 +/- 319 vs 128 +/- 87 ng/ml; p < 0.005). In 36% of the SSc patients, the serum P1CP level was significantly elevated more than two standard deviations above the mean control value. The mean serum P1CP level in patients with diffuse SSc was significantly higher than in those with limited SSc (411 +/- 373 vs 255 +/- 199 ng/ml; p < 0.05). In addition, the SSc patients with elevated serum P1CP levels showed a significantly greater incidence of lung fibrosis and joint involvement than those with normal P1CP levels (p < 0.005 and p < 0.05, respectively). These results suggest that the serum P1CP level is a useful indicator of the severity of disease in SSc patients.

The proliferative activity in dysplasia and carcinoma in situ of the uterine cervix analyzed by proliferating cell nuclear antigen immunostaining and silver-binding argyrophilic nucleolar organizer region staining

The proliferative activity of dysplasia and carcinoma in situ (CIS) in the uterine cervix was examined using proliferating cell nuclear antigen (PCNA) immunostaining and silver-binding argyrophilic nucleolar organizer region (AgNOR) staining. A significant difference in the labeling index of PCNA immunostaining obtained from dysplastic cells in each histopathologic category was demonstrated between severe dysplasia and CIS. There was no significant difference among each category of dysplasia. The frequency of mitotic figures was highest in CIS, followed in decreasing order by severe, moderate, and mild dysplasia, and was closely correlated with the histopathologic classification. There was an intimate correlation between the PCNA and mitotic indexes in severe dysplasia and CIS. However, the mean numbers of AgNORs in each category of dysplasia and CIS were not significantly different, and there was no apparent relationship with the histologic classification. The PCNA index seemed to be a useful means of evaluating proliferative activity in dysplasia and CIS, and especially in distinguishing CIS from severe dysplasia. In addition, the present PCNA index suggests that a considerable alteration of the biologic behavior involving genetic changes occurs during the progression of carcinogenesis from severe dysplasia to CIS. However, AgNOR staining did not appear to reliably represent the proliferative activity in these lesions.

[Endophthalmitis caused by Paecilomyces lilacinus after cataract surgery: a case report]

A case of fungal endophthalmitis caused by Paecilomyces lilacinus after cataract surgery is reported. An 84-year-old woman had been suffering from diabetes mellitus and hypertension. She underwent an uncomplicated extracapsular cataract extraction with implantation of a posterior chamber intraocular lens in the right eye. Approximately one month after the surgery iritis was noted, and treated systemically and topically with corticosteroids and antibiotics. The inflammation was improved by these therapies at first, but worsened when the dose of oral corticosteroid was reduced. White fluffy exudates were present on the iris near the chamber angle with the hypopyon. Removal of the intraocular lens, vitrectomy and medicinal therapy were undertaken. The eye was salvaged but the final visual acuity was counting fingers. Paecilomyces lilacinus was identified from the intraocular specimen taken at the time of surgery. The clinical effects and the results of in-vitro sensitivity test showed that fluconazole and amphotericin B were ineffective, and that econazole, thimerosal and miconazole were effective.

Significance of pH on differentiation of human erythroid cell lines

As physiological factors and compounds, BSA and/or higher pH of the culture medium could induce the erythroid differentiation of cells. Optimum pH values of the culture medium for higher spontaneous differentiation of KU-812 and K562 cells after 7 days cultivation were 7.5 and 7.6, respectively. The synergistic effects on the differentiation were observed by exposure to hemin under the higher pH condition. In the presence of BSA, 25% of KU-812 and 40% of K562 cells became benzidine positive. Synergistic effects of BSA and the higher pH of the medium were also observed.

Genetic polymorphisms in HLA-A, -B, -C and -DR antigens in Japanese patients with palmoplantar pustulosis

Genetic polymorphisms in HLA-A, -B, -C and -DR antigens were investigated in 78 unrelated Japanese patients with palmoplantar pustulosis (PPP) and compared with a total of 472 normal persons. Only HLA-DR9 showed a significantly increased frequency among all HLA antigens investigated (chi 2 = 11.57, p < 0.001). It is suggested that major histocompatibility complex class II antigens including HLA-DR antigen may determine the susceptibility to PPP and PPP may be a distinct disease entity from psoriasis.

Purification and characterization of the receptor for pituitary adenylate cyclase-activating polypeptide

Pituitary adenylate cyclase-activating polypeptide (PACAP) is a 38-amino acid peptide (PACAP38) or a truncated peptide with the same 27 amino-terminal residues (PACAP27). The PACAP receptor was solubilized from bovine brain membranes with digitonin and purified 30-fold by the combination of DEAE-Toyopearl and hydroxylapatite chromatographic analyses. The partially purified PACAP receptors were mixed with biotinylated PACAP27 to form receptor-ligand complexes and then adsorbed onto avidin-agarose. The adsorbed PACAP receptors were eluted with an acidic buffer containing 1.0 M NaCl (pH 4.0). The eluted receptors were purified further by hydroxylapatite and gel filtration chromatography. A single protein band with a M(r) = 55,000-60,000 was found in the final preparation by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and silver staining. Affinity labeling of the purified receptors with 125I-PACAP27 labeled the M(r) 55,000-60,000 protein specifically. The dissociation constant and the specific activity of the purified receptors were 25.8 pM and 17.2 nmol of ligand binding per mg of protein, respectively. Inhibitory constants determined by competitive binding experiments were 30.0 pM for PACAP27, 4.6 pM for PACAP38, and 37.3 nM for vasoactive intestinal peptide. Therefore, the purified PACAP receptor retained high affinity and ligand specificity. The sequence of the amino-terminal 29 residues was derived from the purified receptor.

[A human monoclonal antibody cocktail for experimental mouse infection with clinically isolated strains of Pseudomonas aeruginosa]

A human IgG monoclonal antibody cocktail against Pseudomonas aeruginosa serotypes A, B, E, G, I, and M (MCA5) was tested for its therapeutic effect on the infected mice with clinically isolated P. aeruginosa strains. More than 80% of the collected strains were found to belong to the above six serotypes. Direct agglutination with MCA5 gave slight reduced rates, but over 70% of the strains were agglutinated with MCA5. Fifty percent lethal doses of the representative strains to mice (LD50) were estimated, and 50% protective doses of MCA5 to the infected mice with 5 LD50 of the strains (ED50) were determined. MCA5 was found not to be protective to all the infected mice with above six serotypes but protective only to the mice infected with the agglutinated strains. Confirmation of the agglutination of the causative organism with MCA5 is required for the treatment by MCA5. ED50 for a clinically isolated strain and the virulent stock strain were determined under the various challenge doses. It was found that ED50 increased in parallel with the increase of challenged doses but did not change depending on the virulence of the infected strains. These results indicated that this cocktail worked as opsonin. Opsogenic anti-O IgG antibody could be most effective to protect the opportunistic infections caused by the bacteria which have not so powerful exotoxins.

[Clinical observations on bladder cancer--difference in clinical features with age]

Three hundred and ninety-four patients with transitional cell carcinoma of the bladder who initially visited Yokohama City University Hospital were reviewed according to age group. The patients were divided into four groups, group A (less than 49 years old), group B (from 50 to 64 years old), group C (from 65 to 79 years old) and group D (more than 80 years old). The clinical characteristics as follows were obtained by statistical analysis compared with these four groups. No statistical significance was obtained about frequency of macroscopic hematuria as chief complaint. However, the younger age groups (A and B) tended to visit hospital later after the first symptom of hematuria. The older age groups (C and D) had multiple and large tumor at the first cystoscopic examination. The older age groups (C and D) had high stage and high grade tumor at the first roentgenological examination and transurethral biopsy or resection. The 5-year recurrence free rate after transurethral resection of bladder tumor (TUR-BT) of the older age group (D group) was lower than that of the other groups. The 5-year survival rate of older age group was lower than that of the younger age group. However, no statistical significance between the age groups existed concerning high grade or high stage tumor and survival after total cystectomy. We clarified here that the clinical features of elderly patients who have bladder cancer were significantly different from those of younger patients. Otherwise the prognosis of patients who have high grade and/or high stage bladder cancer were demonstrated to be poor regardless of age.(ABSTRACT TRUNCATED AT 250 WORDS)

A comparative study of cytokeratin expression in Paget cells located at various sites

BACKGROUND

Extramammary Paget disease appears in anogenital, axillary, or other areas. In this study, the authors addressed the question of whether the histogenesis of 35 cases of Paget disease arising at different sites was the same.

METHODS

Specimens of 35 cases of extramammary Paget disease (16 genital; 9 invasive carcinomas of genital; 6 axillary; 1 periumbilical; and 3 perianal), 4 cases of mammary Paget disease, 4 cases of breast carcinomas, and 6 cases of anal carcinomas of perianal spread from primary rectal adenocarcinomas were retrieved and stained by the avidin-biotin-complex method, using various kinds of monoclonal antikeratin antibodies.

RESULTS

There was no significant difference in cytokeratin expression among these cases of extramammary Paget disease. Simple epithelial keratins were expressed in Paget cells in extramammary Paget disease, but no expression of differentiation-specific or noncornifying stratified squamous epithelial keratins was observed, regardless of the degree of invasion. Paget cells in extramammary Paget disease revealed a similar cytokeratin expression to that in secretory cells of normal apocrine or eccrine glands. In addition, there was no significant difference in cytokeratin expression in tumor cells among extramammary and mammary Paget disease, breast carcinomas, and anal carcinomas.

CONCLUSIONS

Cases of Paget disease arising at different locations could not be distinguished from each other based on cytokeratin expression. In addition, antikeratin antibodies against simple epithelial keratins were demonstrated to be more useful for the identification of Paget cells in the paraffin sections than were conventional antibodies, such as an antibody against carcinoembryonic antigen (CEA).

Quantification of occlusive and reperfused myocardial infarct size with Gd-DTPA-enhanced MR imaging

The potential of Gd-DTPA-enhanced magnetic resonance imaging (MRI) for measuring infarct size was assessed in canine hearts. Twelve dogs underwent pre- and post-contrast MR imaging before and after recanalization. Infarct area was identified by triphenyltetrazolium chloride (TTC) staining of postmortal specimens in each case. Recanalization was complete in 10 dogs. High SI area was seen after reperfusion in nine of them; and it showed low signal intensity before reperfusion in seven of them. Two dogs were killed during reperfusion period: neither of them showed a low SI area before reperfusion. Necrotic regions were confirmed by TTC staining in seven of 12 dogs. Both the visual and quantitative assessment (n = 7) indicated that the extent of the low SI area before reperfusion was approximately the same as that of the necrotic region shown by TTC staining, while the high SI area seen after reperfusion was obviously larger than both the necrotic region and the low SI area on pre-reperfusion images. The correlation coefficient between low SI area and necrotic area was 0.98, and between high SI area and necrotic area was 0.80. These results suggest that Gd-DTPA-enhanced MRI may be useful for quantification of infarct size in occlusive myocardial infarction but it may overestimate in reperfused one.

Clinical pharmacokinetics of sparfloxacin

Sparfloxacin is a recently developed fluoroquinolone. The drug has shown potent antimicrobial activity against a wide range of Gram-positive and Gram-negative bacteria, glucose non-fermenters, anaerobes, Legionella spp., Mycoplasma spp., Chlamydia spp. and Mycobacterium spp. Methicillin-resistant Staphylococcus aureus is also susceptible to sparfloxacin. Plasma sparfloxacin concentrations reach a peak (Cmax) of approximately 0.7 mg/L at 3 to 5 hours after a 200mg oral dose. This is followed by a monophasic slow decrease, with an elimination half-life (t1/2) of 15 to 20 hours. The Cmax and area under the plasma concentration-time curve show dose-related increases. Food intake does not affect the absorption and pharmacokinetics of sparfloxacin. Sparfloxacin binds weakly to plasma protein (37%), and exhibits excellent tissue distribution and effective penetration into extracellular fluids. Concentrations of the drug in most tissues are similar to, or higher than, concomitant plasma concentrations. Sparfloxacin distributes slightly into cerebrospinal fluid. The drug is metabolised to a glucuronide. The urinary excretion of the unchanged drug accounts for 10 to 14% of the given dose. The ratio of Cmax values after multiple and single oral doses is 1.3 to 1.4, but other pharmacokinetic parameters of sparfloxacin are not influenced by multiple doses. Even in patients with severe renal failure, no significant prolongation of the half-life is observed after oral administration. Sparfloxacin appears unlikely to affect the pharmacokinetics of theophylline. Antacids containing aluminium hydroxide reduce the oral bioavailability of sparfloxacin by 25 to 35%. Probenecid does not affect sparfloxacin pharmacokinetics. The pharmacokinetic properties of sparfloxacin allow once-daily administration in the treatment of various infections.

Metastatic behavior and tumorigenicity of a human melanoma cell line (MM-RU) after injection into nude mice

The ability of the human amelanotic melanoma cell line MM-RU to produce experimental metastases and to grow tumors at subcutaneous inoculation sites in 4-week-old nude mice was examined. After i.v. inoculation of 10(6) cells, all injected mice (n = 21) developed consistent numbers of metastatic pulmonary colonies within 32 days. The coefficients of variation for the number of colonies were between 17%-23% in three independent experiments. Survival time after i.v. inoculation was 63 +/- 7 days (mean +/- SD) (n = 20). Within 20 days, subcutaneous inoculation of 5 x 10(6) cells resulted in tumor growths of 13 +/- 3 mm (mean +/- SD) at the inoculation sites in all nude mice (n = 12). The MM-RU cell line seems to be a simple, fast vehicle for testing the effect of melanoma growth modulators on experimental pulmonary metastases as well as on subcutaneously growing melanoma.