Post-transfusion alloimmunization to granulocytes and platelets in Japanese patients as determined by the MPHA method

The current occurrence of alloimmunization to granulocytes and platelets after blood transfusion is unclear due to the fact that antibody assays are cumbersome. Using the MPHA method with extracted granulocyte and platelet antigens, a randomized, blinded trial was conducted to investigate three types of alloantibodies in 431 Japanese patients receiving leukocyte-depleted blood transfusions prepared with or without our latest leukocyte-reduction filter. The frequency of granulocyte, platelet and HLA class I alloantibodies was 0.44%, 0.44% and 16.74%, respectively, in patients receiving non-filtered products and 0%, 0% and 0.49%, respectively, in patients receiving filtered products. The granulocyte antibody reacted with an antigen approximately of 51 KDa. The platelet-specific alloantibody was associated with GPIIb/IIIa and GPIa/IIa. The important factors affecting alloimmunization were the transfusion dose and the use of unfiltered platelet products.

Proteolytic release of CD44 intracellular domain and its role in the CD44 signaling pathway

CD44 is a widely distributed cell surface adhesion molecule and is implicated in diverse biological processes. However, the nature of intracellular signaling triggered by CD44 remains to be elucidated. Here, we show that CD44 undergoes sequential proteolytic cleavage in the ectodomain and intracellular domain, resulting in the release of a CD44 intracellular domain (ICD) fragment. Consequently, CD44ICD acts as a signal transduction molecule, where it translocates to the nucleus and activates transcription mediated through the 12-O-tetradecanoylphorbol 13-acetate-responsive element, which is found in numerous genes involved in diverse cellular processes. Expression of an uncleavable CD44 mutant as well as metalloprotease inhibitor treatment blocks CD44-mediated transcriptional activation. In search of the underlying mechanism, we have found that CD44ICD potentiates transactivation mediated by the transcriptional coactivator CBP/p300. Furthermore, we show that cells expressing CD44ICD produce high levels of CD44 messenger RNA, suggesting that the CD44 gene is one of the potential targets for transcriptional activation by CD44ICD. These observations establish a novel CD44 signaling pathway and shed new light on the functional link between proteolytic processing of an adhesion molecule at the cell surface and transcriptional activation in the nucleus.

Malignant mesenchymoma of the lower leg

A 24 year old man had a two year history of a painless mass on his right popliteal region. Magnetic resonance imaging demonstrated a 6 x 8 cm tumour mass in the lateral gastrocnemius. Histological examination of the tumour resected by radical surgery revealed that it consisted of myoblastic sarcoma and chondrosarcoma. Immunohistochemical studies were positive for Ki-67 and p53 throughout the area and for S-100 protein in the chondrosarcomatous area; in addition, they showed partial positivity for muscle common actin (HHF-35), smooth muscle actin, and myoglobin in the spindle cells. The percentages of Ki-67, p53, and p21/WAF1 positive cells in the spindle cell component were 34%, 65.7%, and < 0.1%, respectively. In addition, staining was negative for pancytokeratin, desmin, and glial fibrillary acidic protein. The SYT-SSX, TLS-CHOP, and EWS-FLI1 fusion genes were not detected using the reverse transcription polymerase chain reaction. Given the results, the definitive histological diagnosis is malignant mesenchymoma. This is the first report of malignant mesenchymoma of the lower leg with immunohistochemical and molecular studies.

Soft-tissue osteochondroma in the calcaneal pad: a case report

Soft-tissue osteochondromas of the foot are infrequently occurring lesions. A 65-year-old woman presented with soft-tissue osteochondroma in the soft tissues superficial to the plantar aspect of the calcaneus. The mass was densely ossified without cortical destruction or other alteration in the adjacent calcaneal bone on x-rays and computed tomography images. A 99m Tc bone scan showed a focal area of an increased uptake at the site of the mass below the calcaneus. Magnetic resonance imaging demonstrated high signal mass on T1-weighted images, isointense to fatty marrow, adjacent to the thickened plantar aponeurosis. The mass was completely excised. Histologically, mature lamellar bone was seen centrally, and the periphery was capped with hyaline cartilage. Since the tumor was located in the plantar aponeurosis and comprised of a single nodule of well-developed bone with well-organized endochondral ossification, the pathogenesis of this lesion might be related to metaplasia.

Inhibition of nitric oxide production during global ischemia ameliorates ischemic damage of pyramidal neurons in the hippocampus

We examined the relationship between nitric oxide (NO) production and delayed neuronal death (DND), in the rat hippocampus induced by 21 minutes of transient global ischemia produced by the occlusion of both of the common carotid arteries combined with systemic hypotension. NO production during ischemia and reperfusion was investigated by quantifying the nitrite (NO2-) levels of the in vivo microdialysis samples collected ever 3 minutes from the hippocampus. To determine the origin of NO production, we studied the effects of the focal administration of NG-nitro-L-arginine methyl ester (L-NAME), an inhibitor of the constitutive NO synthase (NOS). We also carried out systemic administration of a selective neuronal NOS inhibitor, 7-nitroindazole (7-NI). Rats were grouped as follows: group 1 (n = 22), vehicle; group 2 (n = 19), L-NAME; group 3 (n = 12), 7-NI; and group 4 (n = 12), a sham operation. The role of NO in the hippocampal DND was investigated histologically one week after ischemia. The level of NO production was significantly decreased in groups 2 and 3 as compared to group 1 in which NO production was significantly increased (p < 0.05). The density of remaining neurons in the CA1 area was significantly reduced only in group 1 (p < 0.01). Taken together, it can be concluded that NO production by neuronal NOS during ischemia and reperfusion resulted in DND in the CA1 region of the rat hippocampus.

The effectiveness of an immobilization device in conformal radiotherapy for lung tumor: reduction of respiratory tumor movement and evaluation of the daily setup accuracy

PURPOSE

To evaluate the daily setup accuracy and the reduction of respiratory tumor movement using a body frame in conformal therapy for solitary lung tumor.

METHODS AND MATERIALS

Eighteen patients with a solitary lung tumor underwent conformal therapy using a body frame. The body shell of the frame was shaped to the patient's body contour. The respiratory tumor movement was estimated using fluoroscopy, and if it was greater than 5 mm, pressure was applied to the patient's abdomen with the goal of minimizing tumor movement. CT images were then obtained, and a treatment planning was made. A total dose of 40 or 48 Gy was delivered in 4 fractions. Portal films were obtained at each treatment, and the field displacements between them and the simulation films were measured for daily setup errors. The patients were repositioned if the setup error was greater than 3 mm. Correlations were analyzed between patient characteristics and the tumor movement, or the tumor movement reduction and the daily setup errors.

RESULTS

Respiratory tumor movement ranged from 0 to 20 mm (mean 7.7 mm). The abdominal press reduced the tumor movement significantly from a range of 8 to 20 mm to a range of 2 to 11 mm (p = 0.0002). Daily setup errors were within 5 mm in 90%, 100%, and 93% of all verifications in left-right, anterior-posterior, and cranio-caudal directions, respectively. Patient repositioning was performed in 25% of all treatments. No significant correlation was detected between patient characteristics and tumor movement, tumor movement reduction, and the daily setup errors.

CONCLUSIONS

The abdominal press was successful in reducing the respiratory tumor movement. Daily setup accuracy using the body frame was acceptable. Verification should be performed at each treatment in hypofractionated conformal therapy.

A myxoid liposarcoma in the lower leg, with a large intra-abdominal metastasis

We report a patient with a large intra-abdominal metastasis of myxoid liposarcoma. The patient first noticed an asymptomatic mass in her left leg in 1985, when she was 20 years old. The mass was left untouched until she realized its rapid growth and consulted a local doctor in 1994. After needle biopsy, she was histologically diagnosed as having a myxoid liposarcoma. She disagreed with the recommendation for an amputation below the knee, made at another hospital. A marginal resection was performed as an alternative treatment. She subsequently underwent three more marginal resections and four intra-lesional resections for repeated local recurrences. In 1997, an abdominal computed tomography scan revealed the presence of multiple intra-abdominal metastases, and the lesions were judged to be inoperable. Ileus and respiratory distress, caused by compression by the abdominal mass, gradually worsened, and she died in 1999, at the age of 34. The girth of her abdomen was 135 cm at the time of death.

Intramuscular haemangioma adjacent to the bone surface with periosteal reaction. Report of three cases and review of the literature

We present three cases of intramuscular haemangioma adjacent to bone in the lower limb. All patients had local pain during the third decade. Plain radiographs showed an irregular or hypertrophic periosteal reaction on the shaft of the fibula and an intramuscular mass adjacent to the bone with inhomogeneous high signal intensity on MRI. These lesions mimic periosteal or parosteal tumours.

Intramuscular haemangioma adjacent to the bone surface with periosteal reaction

We present three cases of intramuscular haemangioma adjacent to bone in the lower limb. All patients had local pain during the third decade. Plain radiographs showed an irregular or hypertrophic periosteal reaction on the shaft of the fibula and an intramuscular mass adjacent to the bone with inhomogenous high signal intensity on MRI. These lesions mimic periosteal or parosteal tumours.

Identification of the transcriptional regulatory sequences of human calponin promoter and their use in targeting a conditionally replicating herpes vector to malignant human soft tissue and bone tumors

The calponin (basic or h1) gene, normally expressed in maturated smooth muscle cells, is aberrantly expressed in a variety of human soft tissue and bone tumors. In this study, we show that expression of the calponin gene in human soft tissue and bone tumor cells is regulated at the transcriptional level by the sequence between positions -260 and -219 upstream of the translation initiation site. A novel conditionally replicating herpes simplex virus-1 vector (d12.CALP) in which the calponin promoter drives expression of ICP4, a major trans-activating factor for viral genes was constructed and tested as an experimental treatment for malignant human soft tissue and bone tumors. In cell culture, d12.CALP at low multiplicity of infection (0.001 plaque-forming unit/cell) selectively killed calponin-positive human synovial sarcoma, leiomyosarcoma, and osteosarcoma cells. For in vivo studies, 10 animals harboring SK-LMS-1 human leiomyosarcoma cells were randomly divided and treated twice on days 0 and 9 intraneoplastically with either 1 x 10(7) plaque-forming units of d12.CALP/100 mm(3) of tumor volume or with medium alone. The viral treatment group showed stable and significant inhibition of tumorigenicity with apparent cure in four of five mice by day 35. Replication of viral DNA demonstrated by PCR amplification and expression of the inserted LacZ gene visualized by 5-bromo-4-chloro-3-indolyl-beta-D-galactopyranoside histochemistry was associated with oncolysis of d12.CALP-treated tumors, while sparing normal vascular smooth muscle cells. In mice harboring two SK-LMS-1 tumors, replication of d12.CALP was detected in a nontreated tumor distant from the site of virus inoculation. These results indicate that replication-competent virus vectors controlled by the calponin transcriptional regulatory sequence may be a new therapeutic strategy for treatment of malignant human soft tissue and bone tumors.

Phosphorylation of neurofibromin by cAMP-dependent protein kinase is regulated via a cellular association of N(G),N(G)-dimethylarginine dimethylaminohydrolase

The neurofibromatosis type 1 (NF1) tumor suppressor (neurofibromin) is thought to play crucial roles in cellular Ras- and cAMP-dependent kinase (PKA)-associated signals. In this study, we identified a cellular neurofibromin-associating protein, N(G),N(G)-dimethylarginine dimethylaminohydrolase (DDAH) that is known as a cellular NO/NOS regulator. The interaction of DDAH was mainly directed to the C-terminal domain (CTD) and to the cysteine/serine-rich domain (CSRD) of neurofibromin, coinciding with the regions containing specific PKA phosphorylation sites. DDAH increased PKA phosphorylation of native neurofibromin in a dose-dependent manner, especially affecting the phosphorylation of CSRD. These findings suggest that the PKA accessibility of neurofibromin was regulated via DDAH interaction, and this regulation may modulate the cellular function of neurofibromin that is implicated in NF1-related pathogenesis.

Postradiation sarcomas of the pelvis after treatment for uterine cervical cancer: review of the CT and MR findings of five cases

OBJECTIVE

To characterize the radiologic features of postradiation sarcomas arising in the pelvic bones following treatment for uterine cervical carcinoma.

DESIGN AND PATIENTS

Five patients who developed postradiation sarcomas in the pelvic bones following radiation therapy for carcinoma of the uterine cervix within the irradiated field were evaluated. Pelvic radiographs, computed tomography (CT) and magnetic resonance (MR) imaging were undertaken in all patients. Histologic confirmation of the tumor type was obtained.

RESULTS

Three patients whose tumors were characterized as an osteosarcoma, an angiosarcoma and a malignant fibrous histiocytoma (MFH) showed a large round or oval mass mainly in the sacroiliac joint which extended into the posterior gluteal soft tissues. In a fourth patient an osteosarcoma developed in the central ilium extending widely into the soft tissues both anteriorly and posteriorly, with calcified areas within the extraosseous mass. The fifth patient had a MFH which showed osteolytic destruction of the cortex of the acetabulum, and minimal soft tissue extension. There were no specific features or signal intensity changes on MR imaging to differentiate these cases from primary sarcomas.

CONCLUSION

Postradiation sarcoma must be considered in patients with uterine carcinoma when a soft tissue mass is seen in the previously irradiated field, especially if the mass is posterior to the sacroiliac joint and the latent period is more than 5 years.

Alternative splicing of fibronectin transcripts in osteochondrogenic tumors

BACKGROUND

Fibronectin (FN) acts in many fundamental biological processes including cell adhesion, migration, proliferation and apoptosis. Although FN shows an ubiquitous expression pattern, alternative mRNA splicing modulates tissue-specific molecular heterogeneity at three regions: extra domain-B, extra domain-A and variable region.

MATERIALS AND METHODS

In the present study, we analyzed the FN mRNA splicing in osteochondrogenic tumors as well as in various normal tissues using the RT-PCR method.

RESULTS

Normal cartilage almost exclusively contained short mRNA lacking alternative exons in all regions. However, 14 osteochondrogenic tumors including osteochondroma, enchondroma, chondroblastoma, chondrosarcoma and osteosarcoma uniformly contained long mRNA with various patterns of alternative exons in the three regions.

CONCLUSION

These results indicated that the lack of regulation excluding the alternative exons may be associated with tumorigenesis in chondrocytes.

Malignant hemangiopericytoma of the breast

A55-year-old woman presented with 1-year history of mass in the right breast. Incisional biopsy showed the tumor to be malignant hemangiopericytoma from its histology. The tumor showed low--intermediate density and peripheral contrast enhancement on CT, and inhomogeneous mixed-signal intensity both on T1W and T2W images, and peripheral enhancement with Gd-DTPA on MRI with no invasion of the duct.

Detection of SYT-SSX fusion gene in peripheral blood from a patient with synovial sarcoma

This report describes a case involving a 22-year-old pregnant woman with synovial sarcoma in the thigh. The patient recognized an elastic hard mass accompanied by a dull pain in the anteromedial portion of the right thigh. Magnetic resonance imaging delineated a deep soft-tissue mass measuring 9 x 7 x 6 cm. Histologic diagnosis of poorly differentiated synovial sarcoma was made based the results of an open biopsy. In this patient, the SYT-SSX fusion gene transcript was detected by nested polymerase chain reaction (PCR) in the peripheral blood collected before biopsy. Two months after wide local resection of the tumor, multiple lung metastases developed. This is the first reported case in which tumor cells were detected by nested PCR in the peripheral blood of a patient with synovial sarcoma. These findings suggest that circulating tumor cells should be monitored because they may serve as a prognostic indicator for synovial sarcoma.

Molecular diagnosis and gene therapy in musculoskeletal tumors

Significant progress has occurred in the molecular analyses of bone and soft-tissue tumors, and genetic studies have led to the development of important new diagnostic tools for the clinical management of patients with sarcomas. The detection of fusion genes induced by tumor-specific translocations, such as EWS-FLI1 in Ewing's sarcoma, SYT-SSX in synovial sarcoma, and CHOP-FUS in myxoid liposarcoma, is becoming significant for clinical diagnosis, because these sarcomas are often indistinguishable from other bone and soft-tissue tumors. Gene therapies with several gene transfer systems have been employed for some incurable cancers. It has been demonstrated that a Herpes simplex virus thymidine kinase (HSV-tk) gene can convert certain nucleoside analogs, such as ganciclovir, which disrupt DNA synthesis and are toxic to nucleosides. Human chondrosarcoma cells transduced with the HSV-tk gene were more sensitive to the cytotoxity of ganciclovir than non-transduced cells. Coculture of chondrosarcoma cells with and without the HSV-tk gene showed a bystander effect. The local injection of gene transduced cells into the chondrosarcoma implanted in nude mice markedly reduced tumor size after the administration of ganciclovir. These results suggested the possibility of gene therapy for chondrosarcoma.

Effects of dietary polyamine deficiency on Trypanosoma gambiense infection in rats

Nishimura, K., Araki, N., Ohnishi, Y., and Kozaki, S. 2001. Effects of dietary polyamine deficiency on Trypanosoma gambiense infection in rats. Experimental Parasitology 97, 95-101. A diet deficient in polyamines decreases the availability of dietary polyamines. We used rats infected with the Wellcome strain of Trypanosoma gambiense to examine the effects of polyamine-deficient chow (PDC) on trypanosome proliferation and symptoms of infection. Rats fed PDC showed limited increase of trypanosome and symptoms of infection and limited loss of body weight and anemia. Survival in these rats was prolonged. Before infection, the heparinized plasma concentration of spermidine in the PDC-fed rats was lower than that in control rats fed with standard chow. After infection, the content of spermidine in red blood cells increased in the control rats, but was only slightly increased in PDC-fed rats. The content of spermidine in the trypanosomes after infection was low in the PDC-fed rats. Decreases in the polyamine content of trypanosomes limited their increase. These observations suggest that a reduction in dietary polyamines may help in the regulation of trypanosome infection.

Evaluation of glass microspheres for intra-arterial radiotherapy in animal kidneys

PURPOSE

To evaluate the histologic distribution of nonradioactive microspheres when intra-arterially infused into normal kidneys, and to evaluate the histologic changes after the infusion.

MATERIALS AND METHODS

The glass microspheres were SiO2 microspheres with a smooth spherical shape measuring 20-30 micrometers in diameter with a specific gravity of 2.2 g/cm3. After the microspheres were mixed with contrast medium, they were infused into the renal artery. Twelve rabbits were sacrificed at 1 day, 3 days, 1 week, and 8 weeks after the treatment, respectively. The specimen was fixed with 10% buffered formalin, specially embedded in methyl methacrylate (MMA) resin and was stained by hematoxylin-eosin. The distribution of the microspheres in the kidney was analyzed microscopically, and histologic changes were also evaluated.

RESULTS

The microspheres were found in arterioles whose diameters were about 20-30 micrometers, within normal kidneys. All vessels containing microspheres were confined to arterioles or arteries. No migration of microspheres was detected in the normal lung or the contralateral kidney. Severe ischemic changes were observed in kidneys, developing within 8 weeks of the infusion.

CONCLUSION

Glass microspheres seemed to be a useful embolic material for intra-arterial radiation therapy.

The use of a permanent magnetic resonance imaging system for radiotherapy treatment planning of bone metastases

PURPOSE

To evaluate the usefulness of magnetic resonance (MR) imaging-based radiotherapy treatment planning (RTTP) for bone metastases in clinical applications.

METHODS AND MATERIALS

MR imaging-based RTTP was carried out for 28 patients with bone metastases using a permanent magnetic MR unit. Twenty-three patients received MR imaging-assisted X-ray simulation, and five underwent MR simulation. In MR imaging-assisted X-ray simulation, the radiation fields defined by an X-ray simulator were modified based on MR information scanned in the exact treatment position using MR skin markers. In MR simulation, both isocenter position and field size were determined on MR images and projected onto the patient's skin.

RESULTS

All lesions unclear on other imaging modalities could be clearly identified on MR imaging. Of the 23 patients receiving MR imaging-assisted X-ray simulation, modification of the original radiation field was necessary in 14 patients (extended in 9, reduced in 4, and completely changed in 1). In MR simulation, appropriate radiation fields could be easily and quickly determined using MR imaging.

CONCLUSION

Methods for MR imaging-based RTTP were developed and clinically implemented for patients with bone metastases, and they were shown to be useful for improving the accuracy of the tumor location. They would provide better therapeutic/palliative benefit to particular patients with bone metastases and could also be applied to other lesions in the future.

Reproducibility of geometric distortion in magnetic resonance imaging based on phantom studies

BACKGROUND AND PURPOSE

Image distortion is one of the major drawbacks of magnetic resonance (MR) imaging for use in radiotherapy treatment planning (RTTP). In this study, the reproducibility of MR imaging distortion was evaluated by repeated phantom measurements.

MATERIALS AND METHODS

A grid-pattern acrylic phantom was scanned with a 0.2-Tesla permanent magnetic unit. We repeated a series of scans three times to evaluate the reproducibility of the distortion. In each series, co-ordinates at 432 intersections of the grid were measured for both T1- and T2-weighted spin-echo (SE) pulse sequences. Positional displacements and their variations at the intersections were calculated.

RESULTS

Averages of the displacements were distributed between 1.58 and 1.74 mm, and maximum values (MAX) between 12.6 and 15.0 mm. Within 120 mm of the image center, the average values ranged from 0.73 to 0.80 mm, and from 3.4 to 5.0 mm for MAX. The absolute values of the positional variations among three series were distributed between 0.41 and 0.88 mm for average values, and between 1.4 and 4.5 mm for MAX.

CONCLUSIONS

The positional variations were mostly within 3 pixels, and most of the positional displacements within the radius of 120 mm of the image center were 2 mm or less. Therefore, it will be possible to use this MR system in RTTP under limited situations, although careful applications are required for RTTP of the body. The development of a computer program to correct image distortion is expected.