Mutational, immune microenvironment, and clinicopathological profiles of diffuse large B-cell lymphoma and follicular lymphoma with BCL6 rearrangement

BCL6-rearrangement (BCL6-R) is associated with a favorable prognosis of follicular lymphoma (FL), but the mechanism is unknown. We analyzed the clinicopathological, immune microenvironment (immune checkpoint, immuno-oncology markers), and mutational profiles of 10 BCL6-R-positive FL, and 19 BCL6-R-positive diffuse large B-cell lymphoma (DLBCL) cases (both BCL2-R and MYC-R negative). A custom-made panel included 168 genes related to aggressive B-cell lymphomas and FL. FL cases were nodal, histological grade 3A in 70%, low Ki67; and had a favorable overall and progression-free survival. DLBCL cases were extranodal in 60%, IPI high in 63%, non-GCB in 60%, EBER-negative; and had a progression-free survival comparable to that of DLBCL NOS. The microenvironment had variable infiltration of M2-like tumor-associated macrophages (TAMs) that were CD163, CSF1R, LAIR1, PD-L1, and CD85A (LILRB3) positive; but had low IL10 and PTX3 expression. In comparison to FL, DLBCL had higher TAMs, IL10, and PTX3 expression. Both lymphoma subtypes shared a common mutational profile with mutations in relevant pathogenic genes such as KMT2D, OSBPL10, CREBBP, and HLA-B (related to chromatin remodeling, metabolism, epigenetic modification, and antigen presentation). FL cases were characterized by a higher frequency of mutations of ARID1B, ATM, CD36, RHOA, PLOD2, and PRPRD (p < 0.05). DLBCL cases were characterized by mutations of BTG2, and PIM1; and mutations of HIST1H1E and MFHAS1 to disease progression (p < 0.05). Interestingly, mutations of genes usually associated with poor prognosis, such as NOTCH1/2 and CDKN2A, were infrequent in both lymphoma subtypes. Some high-confidence variant calls were likely oncogenic, loss-of-function. MYD88 L265P gain-of-function was found in 32% of DLBCL. In conclusion, both BCL6-R-positive FL and BCL6-R-positive DLBCL had a common mutational profile; but also, differences. DLBCL cases had a higher density of microenvironment markers.

Nodular Pulmonary Amyloidosis Preceding Gastric Mucosa-associated Lymphoid Tissue Lymphoma, Initially Suspected to Be Lung Cancer

Nodular pulmonary amyloidosis, a subtype of pulmonary amyloidosis, is a unique disease that can mimic lung cancer on radiographic imaging and is related to lymphoproliferative disorders. In this report, we describe a case of a 76-year-old male who presented with a solitary nodule in his left lower lung lobe on computed tomography that increased from 6 mm to 13 mm in diameter over 40 months. Lung cancer was suspected; however, transbronchial lung biopsy revealed deposition of an eosinophilic and homogeneous amorphous substance, which showed apple-green birefringence under polarized light after Congo red staining, and immunohistochemistry analysis returned positive results for immunoglobulin lambda light-chain. Upper gastrointestinal endoscopy revealed a gastric mucosa-associated lymphoid tissue (MALT) lymphoma. These findings indicated that this was a case of nodular pulmonary amyloidosis that preceded a diagnosis of MALT lymphoma.

Mutational Profile and Pathological Features of a Case of Interleukin-10 and RGS1-Positive Spindle Cell Variant Diffuse Large B-Cell Lymphoma

Diffuse large B-cell lymphoma with spindle cell morphology is a rare variant. We present the case of a 74-year-old male who initially presented with a right supraclavicular (lymph) node enlargement. Histological analysis showed a proliferation of spindle-shaped cells with narrow cytoplasms. An immunohistochemical panel was used to exclude other tumors, such as melanoma, carcinoma, and sarcoma. The lymphoma was characterized by a cell-of-origin subtype of germinal center B-cell-like (GCB) based on Hans’ classifier (CD10-negative, BCL6-positive, and MUM1-negative); EBER negativity, and the absence of BCL2, BCL6, and MYC rearrangements. Mutational profiling using a custom panel of 168 genes associated with aggressive B-cell lymphomas confirmed mutations in ACTB, ARID1B, DUSP2, DTX1, HLA-B, PTEN, and TNFRSF14. Based on the LymphGen 1.0 classification tool, this case had an ST2 subtype prediction. The immune microenvironment was characterized by moderate infiltration of M2-like tumor-associated macrophages (TMAs) with positivity of CD163, CSF1R, CD85A (LILRB3), and PD-L1; moderate PD-1 positive T cells, and low FOXP3 regulatory T lymphocytes (Tregs). Immunohistochemical expression of PTX3 and TNFRSF14 was absent. Interestingly, the lymphoma cells were positive for HLA-DP-DR, IL-10, and RGS1, which are markers associated with poor prognosis in DLBCL. The patient was treated with R-CHOP therapy, and achieved a metabolically complete response.

Copy Number Alteration and Mutational Profile of High-Grade B-Cell Lymphoma with MYC and BCL2 and/or BCL6 Rearrangements, Diffuse Large B-Cell Lymphoma with MYC-Rearrangement, and Diffuse Large B-Cell Lymphoma with MYC-Cluster Amplification

Diffuse large B-cell lymphoma (DLBCL) with MYC alteration is classified as high-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements (double/triple-hit lymphoma; DHL/THL), DLBCL with MYC rearrangement (single-hit lymphoma; SHL) and DLBCL with MYC-cluster amplification (MCAD). To elucidate the genetic features of DHL/THL, SHL, and MCAD, 23 lymphoma cases from Tokai University Hospital were analyzed. The series included 10 cases of DHL/THL, 10 cases of SHL and 3 cases of MCAD. The analysis used whole-genome copy number microarray analysis (OncoScan) and a custom-made next-generation sequencing (NGS) panel of 115 genes associated with aggressive B-cell lymphomas. The copy number alteration (CNA) profiles were similar between DHL/THL and SHL. MCAD had fewer CNAs than those of DHL/THL and SHL, except for +8q24. The NGS profile characterized DHL/THL with a higher "mutation burden" than SHL (17 vs. 10, p = 0.010), and the most relevant genes for DHL/THL were BCL2 and SOCS1, and for SHL was DTX1. MCAD was characterized by mutations of DDX3X, TCF3, HLA-A, and TP53, whereas MYC was unmutated. In conclusion, DHL/THL, SHL, and MCAD have different profiles.

The multilobated morphology is still a better prognosis factor of diffuse large B-cell lymphoma in the R-CHOP era

Diffuse large B-cell lymphoma (DLBCL) is the most common type of B-cell lymphoma. Although the multilobated subtype of DLBCL has been observed since the 1970s, little is known about the clinical significance of this unique variant in the era of rituximab, cyclophosphamide, hydroxydaunorubicin, oncovin, prednisone/prednisolone (R-CHOP) therapy. In this study, the retrospective clinicopathological analysis of 312 patients diagnosed with DLBCL showed that the multilobated DLBCL group comprised 11% of the cases and was predominantly male (p = 0.027), achieved complete remission in the first therapy (p = 0.023), and exhibited germinal center B-cell phenotypes in the Hans algorithm (p = 0.025). The multilobated DLBCL groups had a better prognosis in overall survival (OS) and progression-free survival (PFS) than the non-multilobated DLBCL group (OS, p = 0.006; PFS, p = 0.010). In the multivariate Cox regression analyses for OS, independent prognosis factors were high soluble IL-2 receptor (p = 0.025), high risk of International Prognostic Index, and multilobated morphology (p = 0.031). The most characteristic copy number gains found in more than 50% of the cases were located at 1q, 3p, 10q, 12q, and 14q. Overall, the multilobated morphology in DLBCL exhibits a good outcome in the R-CHOP era.

Clinicopathological analysis of follicular lymphoma with BCL2, BCL6, and MYC rearrangements

Most follicular lymphomas (FL) show t(14;18)/IGH-BCL2 translocation, but rearrangement (R) negative cases exist. A series of 140 FL patients with a BCL2, BCL6, and MYC gene status examined by fluorescence in situ hybridization (FISH) were classified into five groups: (a) BCL2-R group (BCL2-R/BCL6-G/MYC-G) (G, germline), 77 cases; (b) BCL2/BCL6 double-R group (BCL2-R/BCL6-R/MYC-G), 16 cases; (c) BCL6-R group (BCL2-G/BCL6-R/MYC-G), 16 cases; (d) MYC-R group (BCL2-R or G/BCL6-R or G/MYC-R), three cases; (e) Triple-G group (BCL2-G/BCL6-G/MYC-G), 28 cases. The BCL6-R group had different clinicopathological characteristics. It showed lower rates of an advanced clinical stage and bone marrow invasion, less disease progression (p = 0.036), and a 'trend' toward a favorable progression-free survival (PFS) (p = 0.06). It also showed higher rates of grade 3A and MUM1-expression, and when analyzing the interfollicular spread pattern of CD20-positive cells, had fewer cases showing the IF3+ pattern (high interfollicular spread). Moreover, cases with BCL6-R and/or BCL6 gain (with cases of BCL2 rearrangement and/or of copy number gain excluded) correlated with favorable PFS (p = 0.014) and less IF3+ pattern (p = 0.007). We demonstrated that BCL6-R FLs showed unique clinicopathological findings, and FISH of BCL2, BCL6, and MYC is useful for FL diagnosis and clinical management.

AID is a poor prognostic marker of high-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements

Diffuse large B-cell lymphoma with MYC rearrangement is defined as double/triple-hit lymphoma (DHL/THL) or single-hit lymphoma (SHL) by the inclusion of the BCL2 and BCL6 rearrangements status. DHL/THL is called as "high-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements" in the World Health Organization 2017 Classification of Tumors of Hematopoietic and Lymphoid Tissues. To find a prognostic biomarker of DHL/THL, we firstly examined 19 cases (molecular analysis series;10 cases of DHL/THL and 9 cases of SHL) with gene expression profile analysis. The gene expression profile analysis showed that the high expression of AICDA was associated with an adverse prognosis in DHL/THL, but not in SHL. Then, we evaluated immunohistochemical expression of AID, the protein product of AICDA, in 50 cases (molecular analysis series of 19 cases and additional immunohistochemistry series of 31 cases; 12 cases of DHL/THL and 19 cases of SHL) and confirmed that its expression was also associated with an adverse prognosis in DHL/THL. Therefore, AICDA and AID can be a predictor of an adverse clinical outcome in DHL/THL and immunohistochemistry of AID is useful to find DHL/THL-adverse prognosis group.

High PTX3 expression is associated with a poor prognosis in diffuse large B-cell lymphoma

Tumor‐associated macrophages (TAMs) are associated with a poor prognosis of diffuse large B‐cell lymphoma (DLBCL). As macrophages are heterogeneous, the immune polarization and their pathological role warrant further study. We characterized the microenvironment of DLBCL by immunohistochemistry in a training set of 132 cases, which included 10 Epstein–Barr virus‐encoded small RNA (EBER)‐positive and five high‐grade B‐cell lymphomas, with gene expression profiling in a representative subset of 37 cases. Diffuse large B‐cell lymphoma had a differential infiltration of TAMs. The high infiltration of CD68 (pan‐macrophages), CD16 (M1‐like), CD163, pentraxin 3 (PTX3), and interleukin (IL)‐10‐positive macrophages (M2c‐like) and low infiltration of FOXP3‐positive regulatory T lymphocytes (Tregs) correlated with poor survival. Activated B cell‐like DLBCL was associated with high CD16, CD163, PTX3, and IL‐10, and EBER‐positive DLBCL with high CD163 and PTX3. Programmed cell death‐ligand 1 positively correlated with CD16, CD163, IL‐10, and RGS1. In a multivariate analysis of overall survival, PTX3 and International Prognostic Index were identified as the most relevant variables. The gene expression analysis showed upregulation of genes involved in innate and adaptive immune responses and macrophage and Toll‐like receptor pathways in high PTX3 cases. The prognostic relevance of PTX3 was confirmed in a validation set of 159 cases. Finally, in a series from Europe and North America (GSE10846, R‐CHOP‐like treatment, n = 233) high gene expression of PTX3 correlated with poor survival, and moderately with CSF1R, CD16, MITF, CD163, MYC, and RGS1. Therefore, the high infiltration of M2c‐like immune regulatory macrophages and low infiltration of FOXP3‐positive Tregs is associated with a poor prognosis in DLBCL, for which PTX3 is a new prognostic biomarker.

Cutaneous Metastases from Testicular Diffuse Large B-cell Malignant Lymphoma and Bowen Disease: 18F-FDG PET-CT Findings

Here, we report the case of cutaneous metastases from testicular diffuse large B-cell malignant lymphoma (DLBCL) concurrent with Bowen disease evaluated with 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT). A 60-year-old male underwent orchiectomy to remove his left testicle because of DLBCL. Multiple skin lesions appeared 1 month postoperatively. Furthermore, an intractable erythematous plaque localized to the right lower leg was present from 2 years before the operation. 18F-FDG PET-CT images revealed multiple skin lesions with marked FDG uptakes in the face, neck, and thigh of this patient, as well as a lower leg lesion with minimal FDG uptake. Biopsy of both lesions revealed cutaneous metastases from DLBCL and Bowen disease (BD) of the lower leg lesion. 18F-FDG PET-CT images following chemotherapy and resection of BD demonstrated no FDG uptake.

High TNFRSF14 and low BTLA are associated with poor prognosis in Follicular Lymphoma and in Diffuse Large B-cell Lymphoma transformation

The microenvironment influences the behavior of follicular lymphoma (FL) but the specific roles of the immunomodulatory BTLA and TNFRSF14 (HVEM) are unknown. Therefore, we examined their immunohistochemical expression in the intrafollicular, interfollicular and total histological compartments in 106 FL cases (57M/49F; median age 57-years), and in nine relapsed-FL with transformation to DLBCL (tFL). BTLA expression pattern was of follicular T-helper cells (TFH) in the intrafollicular and of T-cells in the interfollicular compartments. The mantle zones were BTLA+ in 35.6% of the cases with similar distribution of IgD. TNFRSF14 expression pattern was of neoplastic B lymphocytes (centroblasts) and “tingible body macrophages”. At diagnosis, the averages of total BTLA and TNFRSF14-positive cells were 19.2%±12.4STD (range, 0.6%-58.2%) and 46.7 cells/HPF (1-286.5), respectively. No differences were seen between low-grade vs. high-grade FL but tFL was characterized by low BTLA and high TNFRSF14 expression. High BTLA correlated with good overall survival (OS) (total-BTLA, Hazard Risk=0.479, P=0.022) and with high PD-1 and FOXP3+Tregs. High TNFRSF14 correlated with poor OS and progression-free survival (PFS) (total-TNFRSF14, HR=3.9 and 3.2, respectively, P<0.0001), with unfavorable clinical variables and higher risk of transformation (OR=5.3). Multivariate analysis including BTLA, TNFRSF14 and FLIPI showed that TNFRSF14 and FLIPI maintained prognostic value for OS and TNFRSF14 for PFS. In the GSE16131 FL series, high TNFRSF14 gene expression correlated with worse prognosis and GSEA showed that NFkB pathway was associated with the “High-TNFRSF14/dead-phenotype”.

In conclusion, the BTLA-TNFRSF14 immune modulation pathway seems to play a role in the pathobiology and prognosis of FL.

Hand-assisted laparoscopic transhiatal esophagectomy with a systematic procedure for en bloc infracarinal lymph node dissection

Laparoscopic transhiatal esophagectomy is a minimally invasive approach for esophageal cancer. However, a transhiatal procedure has not yet been established for en bloc mediastinal dissection. The purpose of this study was to present our novel procedure, hand-assisted laparoscopic transhiatal esophagectomy, with a systematic procedure for en bloc mediastinal dissection. The perioperative outcomes of patients who underwent this procedure were retrospectively analyzed. Transhiatal subtotal mobilization of the thoracic esophagus with en bloc lymph node dissection distally from the carina was performed according to a standardized procedure using a hand-assisted laparoscopic technique, in which the operator used a long sealing device under appropriate expansion of the operative field by hand assistance and long retractors. The thoracoscopic procedure was performed for upper mediastinal dissection following esophageal resection and retrosternal stomach roll reconstruction, and was avoided based on the nodal status and operative risk. A total of 57 patients underwent surgery between January 2012 and June 2013, and the transthoracic procedure was performed on 34 of these patients. In groups with and without the transthoracic procedure, total operation times were 370 and 216 minutes, blood losses were 238 and 139 mL, and the numbers of retrieved nodes were 39 and 24, respectively. R0 resection rates were similar between the groups. The incidence of recurrent laryngeal nerve palsy was significantly higher in the group with the transthoracic procedure, whereas no significant differences were observed in that of pneumonia between these groups. The hand-assisted laparoscopic transhiatal method, which is characterized by a systematic procedure for en bloc mediastinal dissection supported by hand and long device use, was safe and feasible for minimally invasive esophagectomy.

Perioperative outcomes of esophagectomy preceded by the laparoscopic transhiatal approach for esophageal cancer

This study was designed to determine the efficacy of esophagectomy preceded by the laparoscopic transhiatal approach (LTHA) with regard to the perioperative outcomes of esophageal cancer. The esophageal hiatus was opened by hand-assisted laparoscopic surgery, and carbon dioxide was introduced into the mediastinum. Dissection of the distal esophagus was performed up to the level of the tracheal bifurcation. En bloc dissection of the posterior mediastinal lymph nodes was performed using LTHA. Next, cervical lymphadenectomy, reconstruction via a retrosternal route with a gastric tube and anastomosis from a cervical approach were performed. Finally, a small thoracotomy (around 10 cm in size) was made to extract the thoracic esophagus and allow upper mediastinal lymphadenectomy to be performed. The treatment outcomes of 27 esophageal cancer patients who underwent LTHA-preceding esophagectomy were compared with those of 33 patients who underwent the transthoracic approach preceding esophagectomy without LTHA (thoracotomy; around 20 cm in size). The intrathoracic operative time and operative bleeding were significantly decreased by LTHA. The total operative time did not differ between the two groups, suggesting that the abdominal procedure was longer in the LTHA group. The number of resected lymph nodes did not differ between the two groups. Postoperative respiratory complications occurred in 18.5% of patients treated with LTHA and 30.3% of those treated without it. The increase in the number of peripheral white blood cells and the duration of thoracic drainage were significantly decreased by this method. Our surgical procedure provides a good surgical view of the posterior mediastinum, markedly shortens the intrathoracic operative time, and decreases the operative bleeding without increasing major postoperative complications.

Novel diagnostic value of circulating miR-18a in plasma of patients with pancreatic cancer

BACKGROUND

Several recent studies have demonstrated that microRNAs (miRNAs) are stably detectable in the plasma/serum. We hypothesised that miR-18a in the plasma is a potential biomarker in patients with pancreatic cancer.

METHODS

miR-18a is located in the miR-17-92 cluster and reported to be highly expressed in pancreatic cancer tissues. This study was divided into three parts: (1) Confirmation of higher miR-18a levels in primary pancreatic cancer tissues and cell lines than in normal pancreatic tissues and a human fibroblast cell line. (2) Evaluation of the plasma miR-18a assay using quantitative RT-PCR by comparing plasma results obtained from 36 patients with pancreatic cancer and from 30 healthy volunteers. (3) Evaluation of the assay for monitoring tumour dynamics in patients with pancreatic cancer.

RESULTS

(1) The expression of miR-18a was significantly higher in pancreatic cancer tissues (P=0.012) and pancreatic cancer cell lines (P=0.015) than in normal tissues and fibroblasts. (2) Plasma concentrations of miR-18a were significantly higher in pancreatic cancer patients than in controls (P<0.0001). The value of the area under the receiver-operating characteristic curve (AUC) was 0.9369. (3) Plasma levels of miR-18a were significantly lower in postoperative samples than in preoperative samples (P=0.0077).

CONCLUSION

Circulating miR-18a might provide new complementary tumour markers for pancreatic cancer.

Clinical significance of negative esophageal pressure in sleep apnea syndrome

The authors investigated the relationship between esophageal pressure fluctuation (DPes) during sleep and the following parameters: respiratory disorder variables and daytime sleepiness manifested as the Epworth sleepiness scale (ESS). In the younger patient group under 60 years of age (n=33), DPes was correlative to both the apnea-hypopnea index and ESS. However, in the elderly group of 60 years and over (n = 16), the variables showed smaller values than did those in the younger group. These results suggest that DPes may be associated with the aggravating process of sleep apnea syndrome (SAS) in the younger patient.

[Complete remission of liver metastasis from rectal cancer following continuous oral administration of tegafur-uracil after intrahepatic arterial single injection of CDDP and 5-FU]

An intrahepatic arterial injection of CDDP, 5-FU, followed by ten months of oral tegafur-uracil administration (2g/day), induced remission for 3 months or more in a 72-year-old male with rectal cancer and synchronous liver metastasis subsequent to anterior resection of the rectum. Tegafur-uracil showed an excellent anticancer effect against colorectal metastatic liver cancers without loss of QOL because a single-low dose of intraarterial anticancer injection was followed by continuous oral administration of tegafur-uracil, and the chemotherapy could be managed to obtain complete remission of the hepatic lesion.

Posterior canal-activated vestibulocortical pathways in cats

This study was undertaken to investigate vestibulothalamocortical pathways in anesthetized cats. Synaptic connections of posterior canal-activated excitatory vestibuloocular relay (PC) neurons to thalamic neurons were examined by a spike-triggered averaging technique. The averaged potentials evoked in the ventrobasal complex of the thalamus revealed a negative wave with latencies from 0.8 to 1.5 ms. Thirty-six thalamic neurons, which were activated by nose-up head rotation and by contralateral labyrinth stimulation, were mainly located in the ventrobasal complex. Thirteen of these neurons were antidromically activated from the anterior suprasylvian sulcus or postcruciate dimple of the cortex. These results suggest that the PC neurons participate, at least in part, in the vestibulocortical pathways contributing to spatial orientation.

Posterior canal-activated excitatory vestibuloocular relay neurons participate in the vestibulocortical pathways in cats

We have previously reported that axon collaterals of posterior canal-activated excitatory vestibular (PC) neurons project to the contralateral oculomotor nucleus, and rostrally to the thalamus. To elucidate the vestibulothalamocortical pathways we investigated the synaptic connections of the PC neurons with the thalamic neurons by post-spike averaging of compound potentials triggered by spikes of the PC neuron in anesthetized cats. The averaged field potential evoked in the ventrobasal complex (VBC) revealed a spike followed by a negative wave. Latencies of the wave ranged from 0.8 to 1.5 ms. Next, we examined the location and axonal projection of 36 thalamic neurons which were activated by nose-up head rotation and by contralateral labyrinth stimulation. Most of them were located in the VBC and some in the medial geniculate body. Thirteen of the 36 neurons were antidromically activated from the anterior suprasylvian sulcus or postcruciate dimple of the cortex. These results suggest that the PC neurons participate, at least in part, in the vestibulocortical pathways contributing to spatial orientation.

[Clinical evaluation of cefpodoxime proxetil in otorhinolaryngological infections]

In this study, we evaluated the clinical efficacy of cefpodoxime proxetil (CPDX-PR) in otorhinolaryngological infections. The subjects were 205 patients (85 men and 120 women) with various otorhinolaryngological infections, aged from 16 to 81 years (mean 49.2 years): 113 patients had acute infections, 25 patients had chronic infections and 67 patients had acute exacerbation of chronic infections. 1. Clinical evaluation The overall efficacy rate was 75.6%. When classified by disease, the efficacy rate was 84.9%, 60.0%, 65.6% in acute infections, chronic infections and acute exacerbation of chronic infections, respectively. 2. Bacteriological evaluation Frequencies of isolation of different organisms were studied: 49 strains of Staphylococcus aureus, 27 strains of Staphylococcus sp. and 15 strains of Streptococcus sp. were found in the decreasing order of frequencies. Antibacterial activities against S. aureus, Staphylococcus sp. and several other organisms were compared among CPDX-PR, ampicillin, cefaclor, cefteram and norfloxacin: CPDX-PR showed the highest activity. 3. Side effect Mild urticaria was observed in only 1 patient. Abnormal laboratory test results were mild elevation of GOT and GPT in 3 of 43 patients. Based on the above results, we consider that CPDX-PR is useful for treatment of otorhinolaryngological infections.

[Matas procedure in the treatment of spontaneous carotid cavernous sinus fistula: a complication of retinal hemorrhage]

We herein report three cases of the dural internal type of spontaneous carotid cavernous sinus fistula (SCCF) which seemed to be improved by the Matas procedure. Sequential cerebral angiography revealed that thrombosis formation in the peripheral side of the draining vein resulted in a closure of the fistula. During this course of spontaneous regression, retinal findings were transiently exacerbated in some cases. The retinal hemorrhage seemed to be induced by central retinal vein occlusion and hypoxic retinopathy which preceded the spontaneous regression of SCCF. It was confirmed that the Matas procedure should be tried as the first choice for the treatment of SCCF, particularly in the dural internal type. However, fundus findings must be carefully monitored.

Recovery curve of the H-reflex in normal infants, central coordination disturbance cases and cerebral palsy patients within the first year of life

The differences in the recovery curve of the H-reflex in the gastrocnemius within the first year of life were evaluated among 81 normal controls, 40 infants with cerebral palsy and 11 infants with central coordination disturbance (CCD). In normal controls, the recoveries for the groups of under 6 months of age were more marked than those for the groups of 6 months and over of age, with interstimulus intervals of 400 msec and less. The results for the infants with cerebral palsy showed more rapid recovery and facilitation of the reflex compared to those in the normal control infants throughout the first year of life. The recovery curves for the infants with CCD were similar to those for the infants with cerebral palsy in part. It was considered that the recovery curve of the H-reflex might provide additional information for evaluating an infant's motor function.

Gonadotrophin dependence of steroidogenesis by human corpora lutea of different ages during the menstrual cycle

In vitro production of progesterone and estradiol by human corpora lutea of different ages was evaluated in the presence or absence of human chorionic gonadotrophin (HCG). Progesterone production by the luteal tissue was enhanced by as little as 0.1 IU/ml HCG and maximally stimulated by approximately 10 IU/ml HCG. Estradiol production was enhanced by 100 IU/ml HCG. Under control conditions, the synthetic activities of progesterone and estradiol were highest in the luteal tissue isolated from the mid-luteal phase corpora lutea and were lowest in the late luteal phase corpora lutea. The addition of HCG (100 IU/ml) stimulated progesterone and estradiol production by early and mid-luteal phase corpora lutea, whereas HCG had no effects on steroidogenesis by late luteal phase corpora lutea. The results suggest that the age of the corpus luteum might be an important factor governing luteal cell responsiveness to gonadotrophins.

The effect of luteinizing hormone releasing hormone (LHRH) on steroidogenesis by the human luteal tissue

The effect of luteinizing hormone releasing hormone (LHRH) on progesterone and estradiol production was studied in human luteal tissue. Tissue slices were incubated in Ham's F-10 medium under an atmosphere of 95% O2: 5% CO2 at 37 degrees C for 4 h. Slices were treated with or without human chorionic gonadotropin (HCG) in the presence or absence of LHRH. HCG stimulated progesterone and estradiol production by human luteal tissue in a time- and dose-related manner. LHRH stimulated the basal progesterone production in five (one early luteal and four mid-luteal) of 17 corpora lutea, and stimulated the basal estradiol production in three (all mid-luteal) of 16 corpora lutea. On the other hand, LHRH inhibited HCG-stimulated progesterone production in four (two early luteal and two mid-luteal) of 22 corpora lutea, and inhibited HCG-stimulated estradiol production in four (one early luteal and three mid-luteal) of 18 corpora lutea. In the acute short-term incubations of human luteal tissue, therefore, LHRH had little effect on basal and HCG-stimulated steroidogenesis. However, in a few corpora lutea taken in the early or mid-luteal phase, LHRH stimulated basal steroidogenesis and inhibited HCG-stimulated steroidogenesis.

Luteinizing hormone receptors in human ovarian follicles and corpora lutea during the menstrual cycle

The binding of 125I-labeled human luteinizing hormone (hLH) to the 2000-g fraction of human ovarian follicles and corpora lutea during the entire menstrual cycle was examined. Specific high affinity, low capacity receptors for hLH were demonstrated in the 2000-g fraction of both follicles and corpora lutea. Specific binding of 125I-labeled hLH to follicular tissue increased from the early follicular phase to the ovulatory phase. Specific binding of 125I-labeled hLH to luteal tissue increased from the early luteal phase to the midluteal phase and decreased towards the late luteal phase. The results of the present study indicate that the increase and decrease in receptors for hLH during the menstrual cycle might play an important role in the regulation of the ovarian cycle.

Hepatocellular carcinoma metastatic to the oral cavity including the maxilla and the mandible: report of two cases and review of the literature

Two cases of hepatocellular carcinoma metastatic to the oral cavity are presented. One patient had metastases to the maxilla and finally, to the mandible, and the other patient, to the mandible. Both cases histologically showed highly-differentiated trabecular hepatocellular carcinoma which had vascularized stroma, explaining the frequently observed oral hemorrhage. The clinical signs and symptoms described here suggested the existence of a tumor metastatic to the oral cavity, and might indicate an unusual manifestation of hepatocellular carcinoma. Reports of metastatic lesions of hepatocellular carcinoma to the oral cavity, including the mandible, maxilla and gingiva proper, are reviewed.

[Cefotiam passage into the maxillary sinus tissues]

Clinical study was made on cefotiam (CTM) and the following results were obtained. Tissue concentrations of CTM were determined 1 hour after intravenous injection (CTM 1 g) in chronic sinusitis and maxillary cyst. Concentrations of CTM were 16.53 micrograms/g, 13.26 micrograms/g in mucosa of the maxillary sinus, maxillary cyst, respectively. Antibacterial activity of CTM was measured on Escherichia coli, Staphylococcus epidermidis, Aerococcus, Acidaminococcus fermentans, Peptostreptococcus anaerobius; that were isolated from pus of maxillary sinus. The highest MIC on them was 3.13 micrograms/ml.