Massive ascites caused by peritoneal extramedullary hematopoiesis as the initial manifestation of myelofibrosis

An 83-year-old man presented with massive ascites. Cytological examination of the ascites revealed primitive hematopoietic cells. The specimen of bone marrow biopsy disclosed diffuse fibrosis, which suggested myelofibrosis with extramedullary hematopoiesis as the cause of ascites. His symptoms resolved dramatically after administration of hydroxyurea. Ascites formation in myelofibrosis is often attributed to presinusoidal portal hypertension and occurs in the context of well-established disease. This case demonstrates that myelofibrosis may manifest as massive ascites caused by peritoneal implants of myeloid tissues. Extramedullary hematopoiesis should be included in the differential diagnosis of ascites.

Interdigitating reticulum cell tumor of lymph node: a case report and literature review

Interdigitating reticulum cell (IRC) tumor is a rare tumor arising from the antigen-presenting cell - interdigitating reticulum cell. A 41-year-old male presented with lumps in the left neck and bone pain. Further investigations revealed multiple left neck and para-aortic lymphadenopathy, and multiple bony lesions. Histological examination of the lymph node showed proliferation of unusual, large, round neoplastic cells mimicking large cell lymphoma. Immunophenotypic and ultrastructural studies confirmed this tumor to be arising from an interdigitating reticulum cell. A review of reported IRC tumors illustrates the variability of this tumor in clinical and pathological features, which differ from other dendritic reticulum cell tumors.

Colicinogeny among Escherichia coli serotypes, including O157:H7, representing four closely related diarrheagenic clones

Twenty-seven diarrheagenic Escherichia coli (DEC) strains from five closely related, genetically distinct clones (DEC 3, 4, 8, 9, and 10), representing serotypes commonly associated with Shiga-like toxin production, i.e., O15:H-, O26:(H11, H-), O111:(H8, H11, H-), and O157:H7, were evaluated for colicinogeny on Luria agar or Luria agar containing 0.25 microgram/ml mitomycin C to induce colicin production. Ten (37%) of the DEC strains tested were colicinogenic. One of 11 serotype O157:H7 strains, DEC strain 4E, produced a colicin identified as Col D. DEC strains 8B, 9D, and 10B produced Col E1, whereas DEC strain 10A produced Col E2. DEC strains 8A, 8E, 10C, 10E, and 10F produced "untypable" colicins that killed almost all Pugsley Colicin Reference Set strains and the other DEC strains tested. To aid with further characterization of the colicins, plasmids extracted from each colicin-producing (Col+) DEC strain were used to transform E. coli strain DH5 alpha. All Col+ DH5 alpha transformants contained one plasmid ranging in size from 1.3 to 10 kb. Some transformants were stable colicin producers whereas others were unstable. The inhibitory activity and colicin sensitivity and insensitivity profiles of the Col+ transformants were similar to those of the corresponding Col+ donor DEC strains. It appears that the untypable colicins are novel and, thus, warrant further study. Colicin production by some of the DEC strains evaluated partly explains why they were insensitive to standard colicins in a previous study.

Expression of Epstein-Barr virus in patients with Hodgkin's disease in Taiwan

BACKGROUND

The association of Epstein-Barr virus (EBV) with Hodgkin's disease (HD) is intimately related to socioeconomic status. The proportion of HD patients with EBV is high in developing countries but low in developed countries. The aim of this study was to delineate the association of EBV with HD in Taiwan.

METHODS

Tissues from 70 consecutive cases of HD were examined for the presence of EBV, for the latent membrane protein (LMP- 1) by immunohistochemistry, and for EBER-1 by in situ hybridization.

RESULTS

There were 53 males and 17 females, with a mean age of 42 years (range, 7-75 years). Histologic subtypes included nodular sclerosis in 36 cases (51.4%), mixed cellularity in 26 (37.1%), lymphocyte predominance in 6, and lymphocyte depletion in 2. Overall, EBV was expressed in 44 cases (62.9%), with EBER-1 expression detected in 40 (57.1%) and LMP-1 detected in 38 (54.3%). The following histologic subtypes were associated with EBV: lymphocyte predominance in 1 of 6 cases (16.7%), nodular sclerosis in 23 of 36 cases (63.9%), mixed cellularity in 18 of 26 cases (69.2%), and lymphocyte depletion in 2 of 2 cases (100%).

CONCLUSIONS

EBV association with HD is relatively high in Taiwan. Although EBV was detected in all subtypes and at all ages in this study, the low endemic incidence of HD in Taiwan suggests that other factors, besides EBV, play a role in the pathogenesis of HD.

Inhibition of postvitrectomy fibrin using troxerutin

PURPOSE

To evaluate the efficacy of intraocular infusion of troxerutin in the inhibition of fibrin formation after vitrectomy in a rabbit model.

METHODS

Lensectomies and vitrectomies were performed in a masked fashion on seven eyes treated with a 10-mM infusion of troxerutin and on seven control eyes that received only a balanced salt solution infusion. Masked grading of intraocular fibrin formation and intravitreal hemorrhage was performed for 1 week.

RESULTS

On postoperative days 1 and 2, the control group exhibited a greater mean fibrin index (MFI) percentage than the troxerutin-treated group (day 1, 27.7% versus 19.5% MFI; day 2, 14.5% versus 6.1% MFI, respectively). On postoperative day 3, both groups showed an MFI of 1.8%. On postoperative days 5 and 7, both groups showed only minimal presence of fibrin. Neither of the two groups had an increased rate of intraocular hemorrhage.

CONCLUSIONS

Infusion of 10 mM troxerutin resulted in a relative decrease in the amount of fibrin produced without an increased risk of intraocular hemorrhage in treated eyes compared with controls, but the difference was not statistically significant. Further studies may be warranted to evaluate the optimal dose of troxerutin alone or a possible role for its use in conjunction with other drugs employing a different mechanism of action in the prevention of fibrin formation.

Diagnostic and prognostic values of plasma levels of fibrinolytic markers in gastric cancer

In the present study, we determined the plasma and tissue concentrations of tissue-type plasminogen activator, urokinase-type plasminogen activator, plasminogen activator inhibitor-1, plasminogen activator inhibitor-2 and urokinase-type plasminogen activator receptor in 32 patients with pathology-proved gastric cancer. The plasma levels of the same markers were compared in 37 patients with benign gastric ulcer in order to find out if these plasma levels could be used to evaluate the prognostic value in patients with gastric cancer. Plasma plasminogen activator inhibitor-1 was significantly higher in gastric cancer than in benign gastric disease (p < 0.0005), whereas plasma urokinase-type plasminogen activator was significantly lower in patients with gastric cancer than in those with benign ulcer (p = 0.003). There was no significant correlation between tissue and plasma concentrations of the same parameters. The plasma and tissue levels of fibrinolytic parameters were not affected by tumor size or distant metastasis, whereas tumor tissue concentration of urokinase-type plasminogen activator receptor and plasminogen activator inhibitor-2 were significantly higher in N0 than in N1 and N2, and tissue plasminogen activator inhibitor-1 was significantly higher in N0 than in N1. Plasma levels of the five fibrinolytic parameters could not take the place of the corresponding tissue concentrations on the diagnosis and prediction of prognosis in patients with gastric cancer. Tissue concentrations of urokinase-type plasminogen activator receptor and plasminogen activator inhibitor-2, especially the latter, can be used to predict lymph node involvement in patients with gastric cancer.

Continuous infusion cisplatin and etoposide chemotherapy for cancer of unknown primary site (CUPS) in Taiwan, a region with a high prevalence of endemic viral infections

BACKGROUND

To evaluate the efficacy and toxicity of cisplatin/etoposide continuous infusion chemotherapy for cancer of unknown primary site in Taiwan, a region with a high prevalence of endemic viral infections.

METHOD

Between April 1994 and February 1996, 20 patients with a diagnosis of CUPS were treated, including 15 males and five females, of average age 63.3 years (range 41-83 years). Continuous intravenous infusion of etoposide 80 mg/m2 and cisplatin 25 mg/m2 was given for 3 days every 3 weeks. Pretreatment tumor marker and viral serology studies were performed for baseline evaluation. Nearly two-thirds of the patients had poorly differentiated carcinoma. The average number of metastatic sites was 2.65 (range 1-4), with liver and lymph node involvement predominating.

RESULTS

The overall response rate was 25% (95% CI 17.7-32.3%); 30.7% for poorly differentiated cancers and 25% for well differentiated cancers. Median survival was 4 months (range 1-12 months), 4.8 months for patients attaining partial response. Toxicity was moderate, grade 3 and 4 neutropenia occurred in 55% and grade 3 and 4 thrombocytopenia in 40%; other toxicities were mild. CA125 and CA199 were elevated in more than 50% of patients. Viral serology studies were not significantly different from those of the indigenous population.

CONCLUSION

Etoposide and cisplatin combination chemotherapy has modest activity in patients with extensive CUPS and, at the schedule and dosage given, it is associated with moderate toxicity.

Immunoglobulin D multiple myeloma: a case report

Immunoglobulin D (IgD) multiple myeloma is a rare disorder with a poor prognosis. We herein report a case of IgD myeloma presenting with renal failure and bicytopenia. A bone marrow biopsy specimen showed infiltration of homogeneous plasma cells, which stained positively for IgD and light chains. We review the literature and discuss the clinical manifestations, diagnosis and treatment strategy for this rare tumor.

Can advanced hemostatic parameters detect disseminated intravascular coagulation more accurately in patients with cirrhosis of the liver?

BACKGROUND

Laboratory diagnosis of disseminated intravascular coagulation (DIC) is difficult in patients with cirrhosis of the liver due to the complicated hemostatic changes of DIC. More recently, newer molecular hemostatic markers have been used to improve the diagnosis of DIC. This study evaluated the ability of the more advanced hemostatic tests to diagnose DIC in patients with cirrhosis of the liver.

METHODS

A series of hemostatic tests and parameters including activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT), factor VIII assay, antithrombin (AT) activity, fibrinogen, plasminogen, protamine sulfate test (PST), fibrin (ogen) degradation product (FDP), D-dimer, thrombin-antithrombin complex (TAT) (measured by modified antithrombin, ATM), euglobulin lysis test (ELT) and platelet count were performed in 51 patients with cirrhosis of the liver. A diagnosis of DIC was made according to the following parameters and criteria: a) platelets less than 80 x 10(9)/l; b) PT greater than 1.5, c) APTT greater than 1.3; d) TT greater than 24 sec; e) AT less than 60%; f) ATM greater than 14.7 ng/ml (normal, mean +/- 3 SD); g) fibrinogen less than 1.50 g/l; h) positive PST; i) D-dimer greater than 1.0 microgram/ml; j) FDP greater than 20 micrograms/ml; k) ELT less than 150 min; l) plasminogen less than 50%. DIC was diagnosed if six or more of the above items were present, and at least two of them were item (a) to (h), and at least two were item (g) to (l).

RESULTS

Although eight patients had results that fitted the diagnostic criteria of DIC by using the more advanced tests, only two of them were diagnosed with DIC by conventional testing. The concentration of factor VIII in these eight patients did not markedly decrease.

CONCLUSIONS

New tests are not necessary to improve the diagnosis of DIC in patients with cirrhosis of the liver.

Toxicity and anaerobic biodegradability of pyridine and its derivatives under sulfidogenic conditions

Attempts were made to correlate the chemical structure of pyridine and 15 pyridine derivatives with both their biodegradability by estuarine sediment microorganisms under anaerobic conditions and also with their toxicity to the marine bacterium Vibrio fischeri Beijerinck 1889 by using the Microtox bacterial assay. Among monosubstituted pyridines, comparisons of different substituents at positions C-2, C-3, or C-4 atom of the pyridine ring showed that isomers of carboxylpyridine (COOHPYR), hydroxypyridine (OHPYR), and cyanopyridine (CNPYR) were more susceptible to biotransformation than isomers of chloropyridine (ClPYR) and methylpyridine (CH3PYR) in anoxic estuarine sediment slurries under sulfidogenic conditions. Isomers with the functional group at the C-2 or C-3 atom of the pyridine ring were biotransformed faster than those with the same functional group at C-4. The only exception was 4-ClPYR, which was biotransformed within 130 days, while 2- and 3-ClPYR continued to persist in the anoxic sediment slurries. Median effect concentrations (EC50) of pyridine and pyridine derivatives were in the range of 0.027 to 49.1 mmol/L. Pyridine derivatives with -CN and -OH functional groups tended to be less toxic, while pyridine derivatives with -CH3, -Cl, and -COOH functional groups tended to be more toxic. Isomers with the substituent at C-2 were less toxic than the C-3 or C-4 isomers. There was no clear correlation between the pseudo-first-order rate constants for the microbial transformation of pyridine and its derivatives and their toxicity to the marine bacterium.

The influence of live weight, live-weight change and diet on protein synthesis in the skin and skeletal muscle in young Merino sheep

Wool growth is derived directly from protein synthesis in the skin of sheep, and is affected by the nutritional status of the animals. The present experiment examined both protein synthesis in the skin and muscle and wool growth in Merino lambs differing in live weight, intake and dietary protein source. The experiment was a 2(3) factorial design: twenty-four 5-month-old lambs initially weighing 33 kg (heavy) or 25 kg (light) were fed on a hay-based diet with either lupin seed or rapeseed meal as the major protein sources to maintain live weight (M) for 56 d, or were fed at 0.6 M for 28 d (period 1) followed by 28 d at 1.6 M (period 2). Fractional protein synthesis rates (FSR, % per d) in the skin and the m. longissimus dorsi on days 4 and 24 of period 1 and day 4 of period 2 were measured by means of a flooding dose of L-[ring-d5]phenylalanine, and wool growth on a skin patch over period 1 was also measured. The FSR ranged from 13.2 to 20.2% per d in the skin, higher than reported for other breeds, and 1.53-3.07% per d in the muscle. Sheep on the low intake (0.6 M) had significant reductions in FSR, protein content (g), protein synthesis (g/d) in the skin, and wool growth (g/d). The heavy lambs had similar FSR to the light lambs, but had a higher skin protein content and total protein synthesis per unit of skin area (100 cm2) and, therefore, grew more wool. The rapeseed-meal diet increased FSR and wool growth only in the light lambs over the short term. The protein deposited in wool over period 1 was 0.185 of the total protein synthesis in the skin, regardless of live weight, intake or diet, a result similar to other breeds. With the changes in dietary intake, protein synthesis in the skin and muscle responded differentially, with nutrient partitioning at sub-maintenance in favour of wool growth but at supra-maintenance, following a nutrient restriction, in favour of weight gain in young growing sheep.

Gas chromatography/mass spectrometry analyses of [2,3,3-d3] serine, [2,3,3-d3] cysteine and [3-13 C] cysteine in plasma and skin protein: measurement of transsulphuration in young sheep

A new procedure using stable isotope labelled serine (L-[2,3,3-d3] serine) and cysteine (L[13-3-13 C] cysteine) and analysis by gas chromatography/mass spectrometry (GC/MS) has been developed to measure transsulphuration in sheep. The enrichments of the tracers in plasma and skin biopsy samples were measured by GC/electron impact MS analysis of the t-butyldimethylsilyl derivatives. The measured recoveries of the standards enriched with [3-13 C] cysteine from 0.1% to 8%, or with [2,3,3-d3] serine from 0.14% to 14% were greater than 99% of the theoretical values, and the variation coefficients were less than 3% when the enrichment was higher than 0.5%. The use of dithiothreitold (DTT) as a reducing agent before deproteinization of the sample and during the derivatizations successfully increased the cysteine peak area and significantly improved reproducibility in the analysis. The cysteine residues in protein from the skin biopsy were also during the protein hydrolysis with DTT in 6 n HCI. The method was applied to measure transsulphuration of methionine in young sheep. The amount of cysteine derived from transsulphuration accounted for 17% to 21% of the irreversible loss rate of cysteine, depending on the substrate supplies. The results are consistent with other reports. Compared with conventional methods of measuring transsulphuration using radioactive isotopes, the processes of animal experimentation was sample analysis were simple, and there were no radiation hazards. The method should prove useful in studies on the metabolism of methionine and cysteine in human and animals.

Corneal melting after avulsion of a Molteno shunt plate

PURPOSE

We report a case of Molteno shunt avulsion after blunt trauma resulting in corneal melting. The implant's connecting tube had been placed above the superior rectus muscle.

METHODS

Case report.

RESULTS

After blunt trauma, the secondary plate of a double-plated Molteno implant became completely dislodged anteriorly onto the patient's cornea. The corneal tissue entrapped beneath the avulsed plate was found to have extensive melting requiring emergency explantation of the Molteno implant and corneal grafting.

CONCLUSIONS

Corneal melting after Molteno shunt avulsion is a novel finding. Placing a double-plated Molteno implant's connecting tube under the superior rectus muscle might decrease the risk of shunt avulsion after trauma.

Fine structure of the murine leptin receptor gene: splice site suppression is required to form two alternatively spliced transcripts

The fine structure of the murine leptin receptor gene (Lepr) is described. Duplicated ligand binding domains (conserved among cytokine receptors) are found in eight exons (coding exons 3 to 6 and 8 to 11). Thus, it is possible that a single leptin receptor molecule could have two functional ligand binding domains. The transmembrane region of Lepr is in coding exon 16 while the juxtamembrane JAK docking site is in coding exon 17. For all membrane-bound forms, the transcript must include 17 invariant exons and 1 alternatively spliced 3' terminal exon. The transcript encoding the soluble receptor (Re) includes 14 coding exons and an alternatively spliced 3' terminal exon. We have identified two splice variants (Rc and Re) for which there are no intervening sequences between the two final exons. This unusual juxtaposition of exons requires that splice donor sites at the 5' end of the respective terminal exons be ignored in the production of these splice variants. We suggest that splice site suppression is responsible for the formation of two of the alternatively spliced forms of the mouse Lepr gene. The juxtaposition of two coding exons separated by a consensus splice donor sequence is the structural substrate for this mode of alternative splicing. We present evidence that the Rc form is expressed in human tissues while the Re form, the soluble receptor, is not expressed.

Expression of DNA topoisomerase II alpha and multidrug resistance p-glycoprotein in acute leukemia

BACKGROUND

Drug resistance is a major cause of treatment failure in acute leukemia. Overexpression of multidrug resistance gene and decreased activity of topoisomerase II alpha are suggested as two important mechanisms for this resistance.

METHODS

We used immunohistochemical method to determine the expressions of both topoisomerase II alpha (topo II alpha) and p-glycoprotein (gp-170) in bone marrow biopsy specimens from 68 cases of acute leukemia. Patients were divided into four groups: (1) leukemia cells with high score for topo II alpha and negative for gp-170; (2) leukemia cells with high score for topo II alpha and positive for gp-170; (3) leukemia cells with low score for topo II alpha and negative for gp-170; and (4) leukemia cells with low score for topo II alpha and positive for gp-170. The clinical responses were then followed as routine, and the clinical correlation was evaluated by analysis of variance and Pearson Chi-Square test.

RESULTS

The measure of the single parameter (either topo II alpha or gp-170 alone) did not show a significant difference in the overall survival. However, the complete response rate was much higher in the first group patients whose bone marrow reading score was high in topo II alpha and negative for gp-170 expression. Survival duration increased with the increase in the complete response rate.

CONCLUSIONS

Combined parameters of topo II alpha and gp-170 are more useful than any individual parameter for the prognosis of acute leukemia.

The effects of acute and chronic protein depletion and accretion on plasma concentrations of insulin-like growth factor-1, fibronectin and total protein for ruminants nourished by intragastric infusion of nutrients

The relationships of N input or protein status and the concentrations of serum insulin-like growth factor-1 (IGF-1), plasma fibronectin (FN) and total protein (TP) were examined in three experiments with steers and sheep nourished by intragastric infusion of nutrients. In Expt 1, three steers (340 kg live weight) were infused with three levels of volatile fatty acids (0, 300 and 600 kJ/kg metabolic weight (W0.75) per d) and six levels of casein (0, 200, 400, 650, 1500 and 2500 mg N/kg W0.75 per d). Each N treatment was imposed for 5 d. In Expts 2 and 3, five groups of sheep (about 35 kg live weight) were infused with casein at 500 mg N/kg W0.75 per d for 2 weeks followed by 1500, 500 or 50 mg N/kg W0.75 per d in Expt 2, and in Expt 3, with 100 mg N/kg W0.75 per d for 6 weeks or 10 mg N/kg W0.75 per d for 4 weeks. Non-protein energy was maintained constant at 500 kJ/kg W0.75 per d throughout. Daily N balance and total body N content at the end were measured, and protein status was defined as a percentage of cumulative N accretion or depletion in relation to the total body N content at maintenance. It was found that IGF-1 and FN responded rapidly and substantially to altered N input, and that when daily N input was maintained constantly at sub-maintenance, their continuous declines were related closely to progressive protein depletion in the sheep. Plasma TP concentration was independent of N input when N input was altered acutely in the steers, but declined significantly and gradually with severe, chronic body protein depletion in the sheep. Plasma content of TP in the sheep however reduced acutely with a reduction in N input. Plasma volume fell substantially over the first 2 weeks of protein depletion, compensating for the declines in TP content and maintaining TP concentration plateau. The possible implications of the changes in TP concentration and content (concentration x volume) to body protein loss in sheep are discussed.

Nitric oxide and cGMP regulate endothelial permeability and F-actin distribution in hydrogen peroxide-treated endothelial cells

We have previously reported that hydrogen peroxide (H2O2) has a concentration-dependent effect on endothelial permeability and F-actin distribution. In the present study, we considered the involvement of endogenous production of nitric oxide (NO) in the indicated effect of H2O2. This was done by measuring endothelial permeability to sodium fluorescein (MW 376 Da, Na-F) and to different-sized fluorescein-isothiocynate-labeled dextrans (FITC-dextrans) and by staining F-actin with rhodamine-labeled phalloidin in cultured bovine aortic endothelial cells growing on filters. A low concentration of H2O2 (10(-5) M) had no effect on either dense peripheral bands of F-actin (DPBs) or permeability. When N-nitro-l-arginine methylester (l-NAME), an inhibitor of NO production, was coadministrated with 10(-5) M H2O2, DPBs were disrupted and the permeability to FITC-dextran 40 and FITC-dextran 70, but not to Na-F and FITC-dextran 20, was increased. Combining of 10(-5) M H2O2 with l-arginine, a substrate for nitric oxide synthase, caused an increase in DPBs and a decrease in permeability to FITC-dextran 40 and FITC-dextran 70. l-arginine or l-NAME alone had no effect on either F-actin structure or endothelial permeability. A 10-fold higher concentration of H2O2 caused a disruption of DPBs and an increase in permeability; this could be prevented by adding l-arginine. An analogue of cGMP, i.e., 8-Br-cGMP, maintained DPBs and abolished the increase in permeability induced by the treatment with either 10(-4) M H2O2 or a combination of H2O2 and l-NAME. These results suggest that the endogenous production of NO is involved in maintaining endothelial junctions in H2O2-treated cells and that this involvement occurs via a cGMP-dependent mechanism.

Primary low grade B-cell lymphoma of colon mimicking inflammatory bowel disease: a case report

Primary lymphoma of colon is rare in clinical practice and sometimes difficult to diagnose. We described a case of primary, low grade B-cell lymphoma of colon, whose clinical pictures were similar to inflammatory bowel disease. Although the colon mucosa showed diffuse infiltration of lymphocytes with lymphoepithelial lesions on endoscopic biopsy, immunohistochemical stains for B- and T-cell markers were negative. However, the diagnosis of lymphoma was established by positive findings on rearrangement of antigen receptor gene. Clinical symptom of blood-tinged diarrhea subsided after six courses of chemotherapy. Follow-up colonoscopy revealed normal colon mucosa. However, biopsy of colon mucosa still revealed mild proliferation of small lymphocytes. This case has drawn our attention that primary colonic lymphoma may clinically simulate inflammatory bowel disease, and gene rearrangement analysis might be helpful in the diagnosis of malignant lymphoma when traditional histological and immunohistochemical studies fail to provide a definite diagnosis.

Serum responses to the combination of Epstein-Barr virus antigens from both latent and acute phases in nasopharyngeal carcinoma: complementary test of EBNA-1 with EA-D

Elevated serum IgA to antigens of EBV is associated with nasopharyngeal carcinoma (NPC). We have tested 620 NPC sera by ELISA for the presence of antibodies to EBV-encoded DNA binding protein, EBV-specific DNA polymerase, early antigen-diffused (EA-D), EBV nuclear antigen 1 (EBNA-1), EBV-specific thymidine kinase, and BamHI Z fragment EBV replication antigen. Sensitivity of these proteins was in the range of 51.5-79.5% for IgA and 69.4-82.8% for IgG. The complementary use of EBNA-1 with EA-D, however, could increase the sensitivity significantly to 98.1%. Western blot analysis further showed that the combination of EBNA-1 and EA-D is most useful for the detection of NPC. This is the first report of using double biomarkers including EBV gene products from both latent and active infections. The results of this study suggest that EBV in NPC may not be latent alone and that the method may be valuable for the early detection, early treatment, and better survival rate of patients with NPC. Because the application of recombinant EBV protein in ELISA is cost-effective and feasible for mass screening, the method may be of worth for further clinical investigation.

Mitomycin-C induced hemolytic uremic syndrome: a case report and literature review

Hemolytic uremic syndrome spontaneously arises in a few patients with advanced cancer, but it is more commonly related to the use of certain chemotherapeutic agents. Mitomycin-C is, etiologically, the most common causative agent inducing hemolytic uremic syndrome, in a dose dependent manner. We report this syndrome, attributable to mitomycin-C at a cumulative dose of 40 mg/m2, in a gastric cancer patient. A 42-year-old female with stage III gastric cancer underwent radical gastrectomy and was given mitomycin-C at 10 mg/m2 intravenously every four weeks as adjuvant therapy. Hemolytic uremic syndrome was diagnosed three months after the last dose of mitomycin-C administration. The most prominent symptoms included pallor, hypertension and anasarca, with laboratory evidence of microangiopathic hemolytic anemia, azotemia and hyperkalemia. Her disease was progressive, but fortunately stabilized after staphylococcus column A dialysis. Her disease remained in remission for 24 months from the time of diagnosis, and then relapsed in the form of peritoneal carcinomatosis with partial intestinal obstruction.

Phenotype of the obese Koletsky (f) rat due to Tyr763Stop mutation in the extracellular domain of the leptin receptor (Lepr): evidence for deficient plasma-to-CSF transport of leptin in both the Zucker and Koletsky obese rat

The obese phenotypes of the diabetes (db) mouse and fatty fa) rat are due to functional null mutations of the leptin receptor (Lepr). The recessive mutation in the Koletsky (f) obese rat maps to the same genetic intervals as db and fa and fails to complement the fa mutation. Comparison of the sequence of brain Lepr cDNA from +/+ and f/f animals reveals a T2349A transversion resulting in a Tyr763Stop nonsense mutation in the gene just before the transmembrane domain. Virtual absence of Lepr mRNA in whole brain from f/f animals is consistent with the presence of a null mutation. The predicted reduced cerebrospinal fluid (CSF) transport of leptin in both f/f and fa/fa mutants is reflected in the approximately 10-fold lower ratio of CSF/plasma leptin concentration in the obese versus lean animals. However, equivalent CSF leptin concentration between lean and obese rats (fa/fa, f/f) indicates that leptin can enter the CSF through a non-Lepr-mediated mechanism, which may be saturated at normal physiological plasma leptin concentration.

Leiomyosarcoma of the left atrium: a case report

Primary malignant cardiac tumors are uncommon, and cardiac leiomyosarcoma is extremely rare. We reported a case of left atrial (LA) leiomyosarcoma with unusual clinical manifestations. A 28-year-old female presented with unknown cause of fever, body weight loss and anemia for two months. Echocardiography and magnetic resonance image study disclosed a 5 x 3 x 3.6 cm3 lobulated mass in the LA with invasion to its posterior wall. Histologic and immuno-histochemical studies of the resected specimen revealed a picture of leiomyosarcoma. The patient improved after surgical resection and post-operative chemotherapy. The literature was reviewed with a discussion of the clinical manifestations, diagnosis and treatment strategy of this rare tumor. Diagnosis of LA leiomyosarcoma is frequently delayed to make a very poor prognosis. Postoperative chemotherapy should be considered because of highly possible incomplete resection. However, an optimal treatment regimen remains unknown.