Influence of FOXP3 single-nucleotide polymorphism after allogeneic hematopoietic stem cell transplantation

The impact of FOXP3 single-nucleotide polymorphisms (SNP) on clinical outcomes after allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains poorly understood. We investigated the relationship between a FOXP3 SNP (rs3761548) and clinical outcomes in 91 patients with hematological malignancies after allo-HSCT. Multivariate analysis showed that risk of severe chronic graft-versus-host disease (cGVHD) was significantly higher in patients with the FOXP3-3279C/A or FOXP3-3279A/A genotype than those with the FOXP3-3279C/C genotype [hazard ratio (HR), 2.69; 95% confidence interval (CI) 1.14-6.31; p = 0.023]. Therefore, FOXP3 at SNP rs3761548 can be a useful marker for predicting the occurrence of severe cGVHD.

[Acquired thrombotic thrombocytopenic purpura during durvalumab monotherapy for non-small cell lung cancer]

Immune checkpoint inhibitor (ICI)-induced thrombocytopenias are rare immune-related adverse events (irAE), but ICI-related thrombotic thrombocytopenic purpura (TTP) is extremely rare. A 79-year-old woman with non-small cell lung cancer received maintenance therapy with the anti-human PD-L1 monoclonal antibody durvalumab. Four weeks after the last infusion, she developed overt TTP. Remission was achieved by plasma exchange and prednisolone, and the patient has now been recurrence-free for over 12 months. To our knowledge, this is the first report of TTP occurring as an irAE of durvalumab.

Human heterochromatin protein 1 isoform HP1beta enhances androgen receptor activity and is implicated in prostate cancer growth

There are currently few successful therapies for castration-resistant prostate cancer (CRPC). CRPC is thought to result from augmented activation of the androgen/androgen receptor (AR) signaling pathway, which could be enhanced by AR cofactors. In this study, heterochromatin protein 1beta (HP1beta), but not HP1alpha or HP1gamma was found to be an AR cofactor. HP1beta interacted with the AR, and enhanced the DNA-binding ability of AR to androgen-responsive element in the prostate-specific antigen enhancer and promoter regions, and to increase the transcription of AR target genes. In prostate cancer (PCa) tissues, HP1beta expressions correlated with Gleason score and tri-methylation levels of histone H3 lysine 9. Silencing of HP1beta suppressed the growth of AR-expressing PCa cells by inducing cell-cycle arrest at the G(1) phase, similar to inhibition of androgen/AR signaling. Furthermore, HP1beta was overexpressed in castration-resistant LNCaP derivative CxR cells, and HP1beta knockdown also suppressed the cell growth in CxR cells. These findings indicate that HP1beta is involved in the proliferation of AR-expressing PCa cells and progression to CRPC as an AR coactivator. Modulation of HP1beta expression or function might be a useful strategy for developing novel therapeutics for PCa, even in CRPC.

Elevation of ST2 protein levels in cerebrospinal fluid following subarachnoid hemorrhage

OBJECTIVE

To study the mode of appearance of ST2 in cerebrospinal fluid (CSF) after subarachnoid hemorrhage (SAH).

MATERIALS AND METHODS

Immunoprecipitation and subsequent immunoblotting were performed to reveal the existence of ST2 in CSF after SAH. CSF samples from 21 patients were analyzed for ST2 using an enzyme-linked immunosorbent assay system. The ST2 levels were compared between serum and CSF after SAH. The ST2 levels in CSF were measured in six patients operated with other than SAH.

RESULTS

ST2 was secreted into CSF after SAH. The concentration of ST2 was the highest in the samples of the first post-operative day and declined thereafter. The patients operated with other than SAH did not show the elevation of ST2 in CSF.

CONCLUSIONS

This study revealed the presence of ST2 in CSF for the first time and suggested a possibility that ST2 is related to the inflammatory reaction in the central nervous system after SAH.

Augmenting effect of acetic acid for acidification on bactericidal activity of hypochlorite solution

AIMS

Bactericidal activity of chlorine solution is enhanced by weak acidification. We compared the effects of various acids on the bactericidal activity of hypochlorite solution to establish a method for safe and effective use of an acidic hypochlorite solution.

METHODS AND RESULTS

The bactericidal activities of acidic hypochlorite solutions that had been adjusted to pH 5.0 with hydrochloric acid, acetic acid, citric acid, lactic acid, formic acid, phosphoric acid or sulphuric acid against Bacillus subtilis spores were compared. The acidic solutions prepared with hydrochloric acid and acetic acid showed the highest bactericidal activity, and all of the spores (5 x 106 cfu ml(-1)) were killed within 10 min. On the other hand, the solutions prepared with citric acid and lactic acid showed no bactericidal activity against any bacterial strains tested in this study despite the low pH. The amount of chlorine gas produced by the preparation using acetic acid was sixfold less than that produced from the preparation using hydrochloric acid.

CONCLUSIONS

Acetic acid is the most suitable and safe acid for the preparation of an acidic hypochlorite solution.

SIGNIFICANCE AND IMPACT OF THE STUDY

The results of this study provide useful information for establishing a method for safe and effective use of an acidic hypochlorite solution.

Renal cell carcinoma with rhabdoid features: an aggressive neoplasm

AIMS

Only a few reports on renal cell carcinoma with rhabdoid features have been published. This study was performed to investigate the clinicopathological characteristics of renal cell carcinomas with rhabdoid features.

METHODS AND RESULTS

Among 253 cases of renal cell carcinoma in adults, eight cases with rhabdoid features were detected. Rhabdoid areas ranged from 10% to 90% of each of the cases. Seven of the eight cases were TNM stage III or IV, and four of the eight cases died within 8 months of surgery. Immunohistochemically, the rhabdoid areas were positive for CAM 5.2 (4/8), AE1/AE3 (6/8), epithelial membrane antigen (6/8) and vimentin (8/8), and negative for myogenetic markers (0/8). The mean MIB-1 labelling index in the rhabdoid areas was higher than that in the definite carcinomatous areas. Ultrastructurally, perinuclear whorls of intermediate filaments were demonstrated in three of the eight cases using paraffin-embedded blocks.

CONCLUSIONS

The rhabdoid areas in renal cell carcinoma have histological, immunohistochemical and ultrastructural similarities to malignant rhabdoid tumours. Renal cell carcinoma with rhabdoid features is a highly aggressive neoplasm and its malignant behaviour may be due to the high cell-proliferative activity of the rhabdoid areas. Rhabdoid features in renal cell carcinoma may represent the endpoint of clonal evolution of renal cell carcinoma (especially in clear cell type cases).

Presence of a genistein-responsive inhibitory mechanism on interleukin-1alpha-induced NF-kappaB activation

Interleukin 1 (IL-1) is known to activate the signal transduction machinery, including the transcription factor, nuclear factor kappa B (NF-kappaB). The activation mechanism of NF-kappaB has been studied intensively, while the negative regulatory mechanisms of NF-kappaB remain to be clarified. In the present study, we found that genistein, a tyrosine kinase inhibitor, augmented IL-1alpha-dependent NF-kappaB activation, suggesting the presence of a tyrosine kinase mediating a suppression signal on NF-kappaB. As determined by luciferase reporter gene assay using kappaB-responsive element, genistein enhanced IL-1alpha-induced NF-kappaB activation. Although genistein failed to increase luciferase activity at 1 and 3 h after IL-1alpha stimulation, it induced prolonged activation beginning at 6 h after the initial stimulation. We next examined whether genistein augmented the DNA-binding activity of NF-kappaB, using electrophoretic mobility shift assay. In the case of the control experiment, the binding of NF- kappaB to the kappaB-responsive element peaked at 30 min after IL-1alpha stimulation, and decreased thereafter. In contrast, treatment with genistein maintained the maximum binding activity for at least 2 h after stimulation. Moreover, genistein enhanced the IL-1alpha-dependent degradation of IkappaBalpha. Taken together, our results indicate that genistein augments IkappaB degradation, resulting in continuous NF-kappaB activation. This suggests the possibility that tyrosine kinase negatively regulates NF-kappaB.

Elevated soluble ST2 protein levels in sera of patients with asthma with an acute exacerbation

Previous studies have reported that ST2 is preferentially expressed on Th2 cells and plays a critical part in controlling airway inflammation in murine models of asthma. However, the clinical role of ST2 in patients with bronchial asthma remains unclear. In our study, we examined 56 patients with atopic asthma in a nonattack phase and 200 nonatopic normal volunteers for healthy control, and analyzed the relationship of their serum ST2 levels to asthma severity, pulmonary function, and laboratory data. Of the 56 patients with atopic asthma, 30 exhibited asthmatic exacerbation, and their serum ST2 levels were also analyzed. The serum ST2 levels were low, but a statistical difference was found between patients with nonattack asthma and the healthy control group (p < 0.05). We also found a differential rise of serum ST2 level that correlates well with the severity of asthma exacerbation. Furthermore, the serum ST2 levels during asthma exacerbation statistically correlated with the percentage of predicted peak expiratory flow (r = -0.634, p = 0.004) and Pa(CO(2)) (r = 0.516, p = 0.003). These results suggest that soluble human ST2 protein in sera may be related to Th2-mediated allergic inflammation inducing acute exacerbation in patients with atopic asthma.

Identification of human ST2 protein in the sera of patients with autoimmune diseases

Soluble human ST2 protein (IL1RL1-a) in the sera of patients with various autoimmune diseases was identified by a newly developed procedure using specific monoclonal antibodies. After immunoprecipitation and subsequent immunoblotting, a glycosylated protein of about 60 kDa was detected in the sera of SLE patients, but not in the sera of healthy controls. The experiments using gel filtration and SDS-PAGE under a nonreducing condition indicated the existence of the ST2 multimer in serum. The mobility of the natural protein was slower than that of the recombinant human ST2 protein produced by COS7 cells in SDS-PAGE, suggesting a difference of glycosylation between humans and monkeys. The identification of the natural human ST2 protein should be important both to fundamental researches and the further clarification of the clinical implications of the ST2 protein.

Cell proliferative activity and expression of cell-cell adhesion factors (E-cadherin, alpha-, beta-, and gamma-catenin, and p120) in sarcomatoid renal cell carcinoma

BACKGROUND AND OBJECTIVES

Sarcomatoid RCC (renal cell carcinoma) is an uncommon, but not rare, neoplasm which has been shown to have a much worse prognosis than common RCC. The current study was designed to investigate the association of proliferative activity and cell-cell adhesion molecules with sarcomatoid RCC.

METHODS

Proliferative activity (Ki-67 labeling index) and expression of cell-cell adhesion associated molecules (E-cadherin, alpha-, beta-, and gamma-catenin, and p120) were examined using immunohistochemical techniques in 11 cases of sarcomatoid RCC.

RESULTS

In six patients with sarcomatous component more than 50%, five were died within 24 month after diagnosis. The expression of these molecules within the carcinomatous and sarcomatous components of sarcomatoid RCC was compared. The mean Ki-67 labeling index in the sarcomatous components (12.6%) is statistically higher than in the carcinomatous components (3.7%) (P < 0.05). The expressions of E-cadherin, and alpha-, beta-, and gamma-catenin were statistically decreased in the sarcomatous components compared to the carcinomatous components. However, no differences were observed regarding p120 immunostaining.

CONCLUSIONS

The findings of the current study suggest that the range of the sarcomatous component may be a prognostic factor in RCC, and the malignant behavior of sarcomatoid RCC is due to high cell proliferative activity and decreased expressions of E-cadherin and alpha-, beta-, and gamma-catenin in the sarcomatous component.

Cloning and characterization of a chitosanase gene from the koji mold Aspergillus oryzae strain IAM 2660

A genomic copy of the gene coding for chitosanase (csnA) was isolated from Aspergillus oryzae IAM 2660. A. oryzae csnA contains an open reading frame that encodes a polypeptide of 245 amino acids with a calculated molecular mass of 26,500 Da. The deduced amino acid sequence of A. oryzae csnA indicates extensive similarities to those of other fungal chitosanases.

MDR1 gene overexpression and altered degree of methylation at the promoter region in bladder cancer during chemotherapeutic treatment

Overexpression of the multidrug resistance 1 (MDR1) gene is closely associated with the clinical outcome of hematopoietic malignancies, but the alteration of its expression during chemotherapeutic treatment and the precise mechanism underlying MDR1 gene overexpression in solid tumors remains unclear. We determined the expression and degree of methylation at the promoter of the MDR1 gene in bladder cancer. The mRNA levels of the MDR1 gene were found to be markedly enhanced, 3.5- to 5.7-fold higher in bladder cancers after chemotherapeutic treatment than those in untreated primary tumors. The MDR1 gene was overexpressed in recurrent tumors in 89% of patients who showed rerecurrence, whereas overexpression was observed in 25% of the patients without re-recurrence. A statistically significant inverse correlation existed between MDR1 expression and the methylation of 5'CpG sites at the promoter in patients with bladder cancer after chemotherapeutic treatment, with the degree of methylation at several CpG sites, rather than other specific sites, involved in this regulation. Consistent with the increase in MDR1 expression, the frequency of patients with a hypermethylated promoter decreased to 50 and 17% after intravesical and systemic chemotherapy, respectively. Thus, overexpression of the MDR1 gene might be a prognostic marker for intravesical recurrence, whereas methylation of the promoter region negatively regulates MDR1 expression and the appearance of multidrug resistance mediated by P-glycoprotein in bladder cancers.

Distribution of Pb, Cd and Ba in soils and plants of two contaminated sites

Evaluation of metal accumulation in soils and plants is of environmental importance due to their health effects on humans and other biota. Soil material and plant tissue were collected along transects in two heavily contaminated facilities, a Superfund site and a lead-acid battery dump, and analyzed for metal content. Soil lead (Pb), cadmium (Cd) and barium (Ba) concentrations for the Superfund site averaged 55,480, 8.5 and 132.3 mg/kg, respectively. Soil Pb occurred primarily in the carbonate, sulfide/residual and organic chemical fractions (41.6, 28.6 and 16.7%, respectively). Soil Pb, Cd and Ba concentrations for the dump site averaged 29,400, 3.9 and 1130 mg/kg, respectively. Soil Pb occurred mostly in the organic and carbonate fractions as 48.5 and 42.5%, respectively. Pb uptake in the two sites ranged from non-detectable (Agrostemma githago, Plantago rugelii, Alliaria officinalis shoots), to 1800 mg/kg (Agrostemma githago root). Cd uptake was maximal in Taraxacum officinale at 15.4 mg/kg (Superfund site). In the majority > or =65%) of the plants studied, root Pb and Cd content was higher than that for the shoots. Tissue Pb correlated slightly with exchangeable and soluble soil Pb; however, tissue Cd was poorly correlated with soil Cd species. None of the sampled plants accumulated measurable amounts of Ba. Those plants that removed most Pb and Cd were predominantly herbaceous species, some of which produce sufficient biomass to be practical for phytoremediation technologies. Growth chamber studies demonstrated the ability of T. officinale and Ambrosia artemisiifolia to successfully remove soil Pb and Cd during repeated croppings. Tissue Pb was correlated with exchangeable soil Pb at r(2)=0.68 in Ambrosia artemisiifolia.

Purification and characterization of chitosanase and Exo-beta-D-glucosaminidase from a Koji mold, Aspergillus oryzae IAM2660

Chitosan-degrading activity was detected in the culture fluid of Aspergillus oryzae, A. sojae, and A. flavus among various fungal strains belonging to the genus Aspergillus. One of the strong producers, A. oryzae IAM2660 had a higher level of chitosanolytic activity when N-acetylglucosamine (GlcNAc) was used as a carbon source. Two chitosanolytic enzymes, 40 kDa and 135 kDa in molecular masses, were purified from the culture fluid of A. oryzae IAM2660. Viscosimetric assay and an analysis of reaction products by thin-layer chromatography clearly indicated the endo- and exo-type cleavage manner for the 40-kDa and 135-kDa enzymes, respectively. The 40-kDa enzyme, designated chitosanase, catalyzed a hydrolysis of glucosamine (GlcN) oligomers larger than pentamer, glycol chitosan, and chitosan with a low degree of acetylation (0-30%). The 135-kDa exo-beta-D-glucosaminidase,enzyme,named released a single GlcN residue from the GlcN oligomers and chitosan, but did not release GlcNAc residues from either GlcNAc oligomer or colloidal chitin.

The cloning and nucleotide sequence of human ST2L cDNA

The ST2 gene is a member of the IL-1 receptor family and is hypothesized to be involved in helper T cell function, but its functional ligand and physiological role remain unknown. We have cloned the human ST2L cDNA that encodes a distinct type of membrane-bound ST2 protein. The predicted 556-amino-acid sequence showed 67% identity to the mouse ST2L protein. The human ST2 gene (IL1RL1) contains 13 exons and spans 40 kb in length. Its exon-intron organization was elucidated from a registered human genomic sequence derived from chromosome 2q, which contains three other genes belonging to the IL-1 receptor family in an approximately 202-kb genomic region. The tissue distribution of ST2 expression was examined by RT-PCR, and the soluble form (ST2, IL1RL1-a) and ST2L (IL1RL1-b) appear to be expressed differentially. We also established stable transfectants of a human glioblastoma cell line, T98G, that express human ST2L constitutively, and we confirmed cell-surface expression of human ST2L protein on the transfectants.

[Risk factors of anastomotic leak following operations for gastric cancer in the elderly]

The risk factors of anastomotic leak in the elderly following operations for gastric cancer were evaluated by multiple logistic model analysis. Data were taken from 705 operations over a 14-year period. The mean age of patients was 75.8 +/- 7.6 years. The significant risk factors for anastomotic leak were amounts of intra-operative bleeding and male gender. No other factors were significant, including age, preoperative associated diseases, preoperative nutritional states and postoperative complications, some of which were, however, significant factors by univariate analyses. We conclude that we should make every endeavor to lower the amount of intra-operative bleeding in order to prevent postoperative anastomotic leaks in the elderly, especially in male patients.

Construction of ELISA system to quantify human ST2 protein in sera of patients

The human ST2 gene can be specifically induced by growth stimulation in fibroblastic cells, and can also be induced by antigen stimulation in Th2 cells. The gene encodes a soluble secreted protein, ST2, and a transmembrane protein, ST2L, which are closely related to the interleukin-1 receptor. To gain insight into the biological roles of the ST2 gene, three monoclonal antibodies (MAbs) against human ST2 gene products were obtained. To obtain these antibodies, immunization was carried out using two different immunogens: purified soluble human ST2 protein (hST2), and COS7 cells, which express the extracellular portion of human ST2L. 2A5 and FB9 MAbs were derived from the immunization with soluble hST2, and HB12 was derived from the COS7 cell immunization. All three antibodies were shown to detect native forms of the human ST2 gene products by immunoprecipitation, flow cytometry, and enzyme-linked immunosorbent assay (ELISA). In the competitive ELISA using biotinylated and nonlabelled MAbs, neither FB9 nor HB12 affected the binding of 2A5 to ST2 gene products. Based on this result, we constructed a sandwich ELISA system using 2A5 and FB9 to measure the concentration of soluble hST2 in sera. The ELISA, combined with the flow cytometry using these antibodies, will be a useful tool for elucidating the functions of human ST2 gene products in individuals.

Fat detection in granular-cell renal cell carcinoma using chemical-shift gradient-echo MR imaging: another renal tumor that contains fat

Preoperative chemical-shift magnetic resonance images in a 56-year-old man suggested the presence of microscopic fat in the tumor. The surgical specimen showed a granular-cell renal cell carcinoma with papillary architecture, associated with abundant fat-containing foamy histiocytes in the interstitium. The radiologist should include this entity in the differential diagnoses of renal tumors that contain microscopic fat.

Benign mediastinal teratoma complicated by cardiac tamponade: report of a case

We present herein the case of a 48-year-old woman with a benign mediastinal teratoma that had been followed up for 3 years, who developed acute cardiac tamponade. The patient had initially undergone an exploratory sternotomy, at which time the tumor was histologically diagnosed as a benign mature teratoma that could not be resected due to its severe, wide adhesion to the surrounding organs. However, following the development of cardiac tamponade, both sternotomy and right intercostal thoracotomy were employed, and the tumor could be excised with cardiopulmonary bypass standby. High levels of amylase and carbohydrate antigen 19-9 were revealed in the pericardiac effusion fluid. The mRNA expression of inflammatory cytokines including interleukin-1 (IL-1), IL-6, and IL-8 in the tumor tissue was also demonstrated by a reverse transcriptase-polymerase chain reaction analysis. This case illustrates the ultimate natural course of benign mediastinal teratoma and emphasizes the importance of early surgical excision, even when this tumor is asymptomatic.

Presence and expression of a novel variant form of ST2 gene product in human leukemic cell line UT-7/GM

A novel variant cDNA from the human ST2 gene other than ST2 or ST2L was identified and tentatively named ST2V. Alternative splicing inserts a new exon which leads to a change in the C-terminal portion of ST2, causing it to gain a hydrophobic tail instead of losing the third immunoglobulin-like domain. ST2V is expressed in human leukemic cell line UT-7 and its sublines UT-7/GM, UT-7/EPO, and UT-7/TPO, in addition to human helper T cell line 5C10. The amount of ST2V mRNA is greatly diminished when UT-7/GM cells are induced to differentiate into either erythroblastic or megakaryoblastic phenotypes. The possible roles of the ST2V in growth and differentiation are intriguing.

Different promoter usage and multiple transcription initiation sites of the interleukin-1 receptor-related human ST2 gene in UT-7 and TM12 cells

The ST2 gene encodes receptor-like molecules that are very similar to the type I interleukin-1 receptor. Two distinct types of the ST2 gene products, ST2 (a soluble secreted form) and ST2L (a transmembrane form) are produced by alternative splicing. Here we demonstrate that the human ST2 gene has two alternative promoters followed by distinct noncoding first exons, which are located more than 8 kb apart and are spliced to the common exon 2 containing the translation initiation site. Within 1001 bp upstream of the transcription initiation site of the cloned distal promoter, there are four GATA-1. The main promoter used for the expression of the ST2 gene in UT-7, a human leukaemic cell line, is distinct from that in TM12, a human fibroblastic cell line. Although UT-7 cells use both distal and proximal promoters, the distal promoter is used dominantly for expression of both ST2 and ST2L mRNA. On the other hand, almost all transcription in TM12 cells starts from the proximal promoter. These results contrast with those of former studies on the rat system, in which ST2 and ST2L mRNA were generated by use of the proximal and distal promoters, respectively. Furthermore, UT-7 cells use multiple transcription initiation sites in both the proximal and distal promoters, whereas the transcription of the ST2 gene in TM12 cells starts at a unique site. Intriguingly, these results suggest that ST2 and ST2L proteins have distinct functions in different cells within different biological systems, such as those of growth control, differentiation and immunological responses.

Presence of ganglia within the prostatic capsule: ganglion involvement in prostatic cancer

BACKGROUND

The presence of ganglia within the prostatic capsule (capsular ganglia) is a poorly understood phenomenon. If cancer invasion into or around ganglia is identified in a needle biopsy specimen, such a finding may be diagnosed as an extraprostatic extension. In this study, the presence of capsular ganglia was clarified. Furthermore, we discuss the significance of these ganglia in prostatic cancer patients.

METHODS

The study group comprised a total of 42 patients, who had all undergone a radical prostatectomy for prostate adenocarcinoma with a relatively small volume. After surgery, the step-sectioned radical prostatectomy specimens were histologically evaluated.

RESULTS

In 22 of 42 cases, capsular ganglia were recognized. With respect to the distribution of the capsular ganglia, the ganglia were most frequently observed at the posteriolateral aspect of the prostatic base. Morphologically there were no obvious differences between the capsular and periprostatic ganglia. Moreover, in 3 of 5 cases with cancer involvement into the capsular ganglia, such involvement was not predictive of extraprostatic extension.

CONCLUSIONS

The presence of capsular ganglia needs to be clarified in prostatic cancer patients. Our findings therefore suggest that cancer involvement either in or around the ganglia should not be immediately interpreted as indicating an extraprostatic extension, if such a finding is recognized in a needle biopsy specimen.

[Clinicopathological analysis of transition zone cancer of the prostate: the clinical significance of coexistent non-transition zone cancer foci]

BACKGROUND

Dominant cancer of transition zone origin of the prostate (TZ cancer) has been frequently detected, because ultrasound-guided systematic biopsies have been generalized. In cases of TZ cancer, we attempted to determine clinical significance of coexistent non-TZ cancer foci.

MATERIALS AND METHODS

Twenty cases with TZ cancer who underwent radical prostatectomy or cystoprostatectomy were clinicopathologically evaluated using step-sectioned specimens.

RESULTS

In TZ cancer foci, there were extraprostatic extension in 5 cases (25%), seminal vesicle invasion in 2 cases (10%), positive surgical margin in 6 cases (30%) and bladder neck invasion in 4 cases (20%). The extraprostatic extension and the positive surgical margin occurred at the anterior or anterioapical portion of the prostate in all the cases. On the other hand, 17 (85%) had coexistent non-TZ cancer foci. In non-TZ cancer foci, there were extraprostatic extension in 3 cases (15%), seminal vesicle invasion in 1 case (5%) and positive surgical margin in 1 case (5%). The extraprostatic extension and the positive surgical margin occurred at the posteriolateral portion of the prostate in all the cases. In 3 cases a coexistent non-TZ cancer focus showed the extraprostatic extension, the seminal vesicle invasion or the positive surgical margin, although a TZ cancer focus were organ-confined.

CONCLUSION

We should add attention to coexistent non-TZ cancer foci in TZ cancer cases. Particularly, we believe that pre-operative evaluation of non-TZ cancer foci is needed in TZ cancer cases of the candidates for nerve-sparing radical prostatectomy.

Mediastinal lymph node metastasis of colon cancer: report of a case

We herein describe a patient with mediastinal lymph node metastases which occurred after both a primary sigmoid colon cancer and metachronous ovarian metastasis had been resected. The most likely route of metastases to the mediastinum in this case is the paravertebral venous plexus probably connected to the ovarian metastasis, or so-called remetastasis. This case illustrates that the mediastinum is thus a possible metastatic site in patients with colon cancer. Surgeons should therefore pay attention to the mediastinum as well as the lung fields when checking chest X-ray films during a follow-up of patients after a resection of colon cancer.

MR detection of cytoplasmic fat in clear cell renal cell carcinoma utilizing chemical shift gradient-echo imaging

We attempted to determine whether cytoplasmic fat in clear cell renal cell carcinoma (RCC) can be identified by chemical shift gradient-echo magnetic resonance imaging (CSI). CSI was performed for 22 clear cell RCCs and 30 other renal tumors (including 16 non-clear cell RCCs), all of which were surgically proven. Signal reduction in out-of-phase images of these tumors was retrospectively evaluated and compared. The signal loss ratio (SLR) was defined and calculated. Fat staining of specimens from 16 tumors was performed and correlated with SLR. SLR was significantly higher in clear cell RCCs than in non-clear cell RCCs (P < 0.001). There was a significant correlation between degree of fat staining positivity of the specimens and SLR (P < 0.01). When signal reduction in out-of-phase images suggested the diagnosis of clear cell RCC, correct diagnosis of this entity was made in resected renal tumors with sensitivity, specificity, and accuracy of 82%, 90%, and 87%, respectively. CSI can demonstrate cytoplasmic fat in clear cell RCCs, which helps to differentiate this entity from other RCCs.

Early carcinoma of the distal second part of the duodenum treated by wedge resection

A case of early carcinoma of the distal second part of the duodenum, in a 74-year-old man, is presented. Endoscopic retrograde cholangiopancreatography was performed for diagnosis of a common bile duct stone. During this procedure, small elevated lesions were found incidentally in the distal second part of the duodenum, and the histologic examination of a biopsy specimen showed adenocarcinoma. The lesions were removed by wedge resection, and pathologic examination revealed duodenal carcinoma limited to the lamina propria. Although carcinoma of the duodenum, other than of the ampulla of Vater region, is very rare, it is sometimes possible to detect asymptomatic early tumors. However, this requires careful observation of the entire duodenal mucosa, including that of the distal duodenum, at duodenoscopy.

[Two elderly patients with intestinal perforation caused by press-through package]

We report two cases of intestinal perforation caused by accidental swallowing of Press-Through Packages (PTP). The first case occurred in a 90-year-old woman with moderate dementia. She was admitted to our hospital because of abdominal pain and intestinal obstruction. She showed symptoms and sign of peritonitis and underwent abdominal surgery. The postoperative diagnosis was diffuse peritonitis due to a perforated rectal ulcer caused by the sharp corners of an accidentally swallowed PTP. The second case occurred in an 82-year-old woman with recurrent symptoms and signs of intestinal obstruction. She underwent abdominal surgery and the operation revealed an ileal perforation due to penetration by the sharp edge of a PTP. Both patients were discharged in good condition. PTPs are rapidly becoming popular as packaging for tablets and capsules. However, reports of accidental swallowing of PTPs have recently been increasing. In most cases, the PTPs were found in the esophagus and removed endoscopically. Progression of accidentally swallowed PTPs to the intestines is rare. However, when this occurs, the patient's condition becomes more serious. We propose that drugs should not be dispensed in PTPs but rather handed to the patients, especially to elderly patients, or when impossible, the corners of PTPs should be rounded.

[Parkinsonism and postoperative complications in the elderly]

The risk factors for postoperative morbidity and mortality in elderly patients with Parkinsonism after gastrointestinal surgery were evaluated by univariate and multivariate analyses in comparison to those of patients with cerebrovascular disease and to those of patients with no comorbid condition. Data were obtained on 36 patients with Parkinsonism (PK), 77 with cerebrovascular disease (CVD) and 120 with no comorbid condition (ND). All data were adjusted for age, sex and operative procedure. The postoperative morbidity rate was highest in the PK group (77.8%), followed by the CVD group (70.1%), and both differed significantly from the rate of the ND group (32.5%). Gastrointestinal and pulmonary complications and delirium were the major postoperative complications, and were significantly more common in the PK group than in the ND group. Patients in the PK group had the longest postoperative hospital stay, followed by those in the CVD and ND groups; the differences were significant between the PK and ND groups and between CVD and ND groups. The PK group had the highest operative and hospital mortality rates, and they differed significantly from the ND group. Hayashi's second method of quantification was used to assess the risk factors for postoperative death. The highest partial correlation coefficient was that found for postoperative pulmonary complication. We conclude that we should pay close attention to postoperative respiratory management, particularly in elderly patients with Parkinsonism, to prevent pulmonary complications and reduce postoperative mortality.

The expression of ST2 gene in helper T cells and the binding of ST2 protein to myeloma-derived RPMI8226 cells

The ST2 gene, which is specifically induced by growth stimulation, encodes interleukin-1 receptor-related proteins. Using the RT-PCR method, we found that the ST2 gene was broadly expressed in hematopoietic cell lines. It was also expressed specifically in helper T cell lines among lymphocytic cell lines. We analyzed the expression of ST2 in mouse helper T cell subsets with Northern blotting analysis. Mouse Th1 cell lines so far studied did not express ST2 mRNAs. On the other hand, one of the Th2 cell lines, D10, expressed ST2L (transmembrane form) without stimulation, while co-stimulation by PMA and A23187 induced ST2 (soluble form) mRNA. These results suggest that the ST2 gene is involved in the regulation of the immune system. IL-1 alpha, IL-1 beta, and receptor antagonist did not bind to ST2L protein, which prompted us to search for the specific ligand of ST2. The recombinant human ST2 protein was purified and labeled with FITC. The labeled human ST2 protein bound with myeloma-derived RPMI8226 cells among the various B-cell lines, indicating possible involvement of ST2 in T-cell/B-cell interaction.

[Clinical review of 105 cases of adrenal tumor, with special reference to incidental tumor]

We reviewed 105 patients with adrenal tumor diagnosed at our institute from January 1984 to December 1993. In 74 patients tumors were symptomatically diagnosed (the symptomatic group), while in the remaining 31 patients tumors were incidentally detected (the incidental group). In 5 cases of the incidental group, tumors were found at a routine health examination, whereas in the remaining 26 cases tumors were found during the examination or treatment for unrelated diseases. On both the incidental group and symptomatic group, higher right-to-left side ratio was noted in the laterality of tumors detected by ultrasound scanning. The size of tumors in the incidental group was significantly larger than that in the symptomatic group, but there was no significant difference in size between the tumors detected by ultrasound and those detected by CT scan in either the symptomatic group or in the incidental group. In the symptomatic group 71 patients (95.9%) were found to have functioning tumor, where the most common diagnosis was primary aldosteronism (44 cases), and 68 of the 71 patients received adrenalectomy. While in the incidental group 12 patients (38.7%) were found to have functioning tumor, where the most common diagnosis was pheochromocytoma (7 cases), followed by Cushing's syndrome (3 cases) including one case with so-called pre-Cushing's syndrome, and all of the 12 patients received adrenalectomy. Of 16 primary incidental adrenal tumors which did not have any hormonal functions, 5 tumors larger than 30 mm in diameter were resected and the remaining 11 tumors were followed up without operation. Since the incidence of incidental adrenal tumor may increase in the future, careful diagnosis and decision of indication for surgery are required.

[Risk factors of operative death and prognosis following operations for esophageal cancer in the elderly]

Risk factors of operative death and prognosis in the elderly following operations for esophageal cancer were evaluated by multivariate analyses. Data were obtained from 45 operations over a 14-year period in patients of a mean age of 72.6 +/- 6.3 years. Using a multiple logistic model analysis, it was determined that the significant risk factor of death within 50 postoperative days was postoperative pulmonary complication. No other factors were significant as risk factors with regard to survival. Cox's proportional hazards model analysis was used to assess the prognostic factors of long-term survival following operations. Independent predictors were the stage of cancer and age. We conclude that two points are essential to improve the survival rate of elderly patients with esophageal cancer; first, postoperative special attention in order to prevent pulmonary complications and secondly, performing operations at as early a stage of cancer as possible.

[Gastric cancer in the elderly]

Gastric cancer in the elderly was evaluated with regard to age-related pathomorphological changes. Resected gastric cancer was studied with regard to location, stage, morphology and histology in male young old (65-74 years old) which were 25 cases and 31 lesions, respectively male middle old (75-84 years old); 104 cases and 120 lesions, male very old (85 years-); 96 cases and 110 lesions, female young old; 22 cases and 31 lesions, female middle old; 91 cases and 106 lesions, female very old; 51 cases and 55 lesions. Multiple gastric cancers were more frequent in female older group. In early cancer the frequency of elevated type increased significantly and that of depressed type decreased in very old group. In advanced cancer Borrmann I type was not so common in very old group. Histologically the frequency of signet ring cell cancer decreased and of tubular adenocarcinoma and of papillary adenocarcinoma increased significantly in female very old group. Hepatic metastasis increased significantly in male very old group. Lymph node metastasis and peritoneal metastasis did not show any change in age-related frequency.

[A report of leiomyosarcoma of the esophagus]

Leiomyosarcoma of the esophagus is an uncommon disease of which only 97 cases including the present case have been reported in Japan. We report a case of the tumor which showed multiple hematogenous metastases after surgery. A 73-year-old male was admitted complaining of dysphagia and vomiting. Esophagography and endoscopy revealed a large protruding lesion in the lower esophagus. CT scanning revealed threefold-sized extramural mass. Boring biopsies failed to yield evidence of malignancy. However, we performed surgical treatment because of the uncommon size for a benign tumor. The excised tumor was 11 x 9 x 5 cm in size and was diagnosed histologically as leiomyosarcoma of the esophagus without any nodular involvement. Metastatic tumor in the right rib was found 14 months after the operation. Radiotherapy failed to decrease tumor size but eliminated pain. Bone metastases appeared successively and the patient died 3 years and 4 months after operation. Chemotherapy had no effect. Autopsy revealed metastases to the ribs, vertebrae, sternum, pelvic kidneys and diaphragm, but no local recurrence. There is a great need for the development of effective anti-cancer drugs for leiomyosarcomas, particularly in cases with extensive metastasis, such as presented here.

Prostatic acid phosphatase assay with self-indicating substrate 2,6-dichloro-4-acetylphenyl phosphate

We characterized six self-indicating substrates, synthesized as the derivative compounds of acetylphenyl phosphate, for serum prostatic acid phosphatase (PAP) activity. One of the substrates, 2,6-dichloro-4-acetylphenyl phosphate (DCAPP), is superior to others in terms of stability, affinity, and low Km for PAP. The hydrolyzed product, 2,6-dichloro-4-acetylphenol (DCAP), has a maximum absorption at 334.2 nm, a pKa of 4.15, and a molar absorptivity at 340 nm of 21,490 L.mol-1.cm-1 in citrate-HCl buffer, pH 5.4. PAP activity was assessed by subtracting tartaric acid-inhibited acid phosphatase activity from total acid phosphatase activity. Our assay system involving DCAPP is a unique kinetic method that shows good reproducibility, wide analytical dynamic range, and high specificity for PAP. Moreover, it is easily adaptable to automated analyzers because the product, DCAP, can be monitored at 340 nm.

Prostatic acid phosphatase assay with self-indicating substrate 2,6-dichloro-4-acetylphenyl phosphate

We characterized six self-indicating substrates, synthesized as the derivative compounds of acetylphenyl phosphate, for serum prostatic acid phosphatase (PAP) activity. One of the substrates, 2,6-dichloro-4-acetylphenyl phosphate (DCAPP), is superior to others in terms of stability, affinity, and low Km for PAP. The hydrolyzed product, 2,6-dichloro-4-acetylphenol (DCAP), has a maximum absorption at 334.2 nm, a pKa of 4.15, and a molar absorptivity at 340 nm of 21,490 L.mol-1.cm-1 in citrate-HCl buffer, pH 5.4. PAP activity was assessed by subtracting tartaric acid-inhibited acid phosphatase activity from total acid phosphatase activity. Our assay system involving DCAPP is a unique kinetic method that shows good reproducibility, wide analytical dynamic range, and high specificity for PAP. Moreover, it is easily adaptable to automated analyzers because the product, DCAP, can be monitored at 340 nm.

[Prognostic factors influencing survival after operations for gastric cancer in the elderly]

The prognostic factors influencing survival after operations for gastric cancer in the elderly were evaluated by Cox's proportional hazards model analysis. Data were obtained from 511 operations over a 10-year period, in patients with a mean age of 75.6 +/- 7.9 years. The significant prognostic factors of survival out of 47 examined risk factors were, in order of standardized coefficient values, (1) stage of cancer, (2) %IBW, (3) peritoneal dissemination (P-factor), (4) multiple non-gastric cancers, (5) postoperative hepatic injury and (6) postoperative cardiac complication. No other factors, including preoperative associated diseases and postoperative pulmonary complication (the major risk factor of operative death), were significant risk factors of survival. We conclude that by giving special postoperative attention to prevent hepatic injury and cardiac complication, the length of survival of elderly patients with gastric cancer will improve.

[Changes in surgical treatment of peptic ulcer in the elderly by H2-blockers]

It has common knowledge that the advent of H2-blockers has radically changed the treatment of peptic ulcer. We reviewed 26,667 endoscopic examinations, 5,800 consecutive autopsies and 134 consecutive patients operated for peptic ulcer over an 18-year period to evaluate the effects of H2-blockers on the treatment of peptic ulcer in the elderly (> or = 60 years of age). The number of operations for peptic ulcer in the elderly markedly declined after H2-blocker therapy was introduced. This is mainly due to decreased operative indications for gastric bleeding as a result of conservative treatment. However, the incidence of perforating ulcers has hardly changed even after the introduction of H2-blockers. More than 90% of these cases were non-diagnosed or non-treated ulcers and 50% of them were NSAID- or steroid-treated, which is characteristic in the elderly. We conclude that patients to be treated by anti-inflammatory drugs should be screened by endoscopy, and should be given anti-ulcer drugs prophylactically if necessary.

The complete amino acid sequence of subunit d of rat liver mitochondrial H(+)-ATP synthase

Subunit d of H(+)-ATP synthase from rat liver mitochondria was isolated from the purified enzyme by reverse-phase high performance liquid chromatography. The partial amino acid sequence of the subunit was determined by automated Edman degradation of the peptide fragments. The nucleotide sequence of subunit d of rat liver H(+)-ATP synthase was determined from a recombinant cDNA clone isolated by screening a rat hepatoma cell line H4TG cDNA library with a probe DNA. The sequence was composed of 581 nucleotides including a coding region for the import precursor of subunit d and noncoding regions on the 5'- and 3'- sides. The possible precursor of subunit d and its mature polypeptide deduced from the open reading frame consisted of 161 and 160 amino acid residues with molecular weights of 18,763 and 18,631, respectively. Subunit d is a hydrophilic protein with an isoelectric point of 6.19. The sequence of the rat subunit d is highly homologous with that of subunit d of bovine heart and slightly similar to that of the subunit d of the yeast mitochondria. However, it had no homology with the sequence of any of the subunits of bacterial or chloroplast H(+)-ATP synthase.

Molecular cloning and sequence of two cDNAs for human subunit c of H(+)-ATP synthase in mitochondria

Two cDNAs encoding different signal peptides (61 and 66 amino acid residues) and the same mature protein have been cloned from a human cDNA library with a rat subunit c cDNA. The amino acid sequence of the mature human subunit c of mitochondrial H(+)-ATP synthase was completely identical with those of the mature bovine, sheep and rat subunit c.