Human herpesvirus-8 negative primary effusion lymphoma with complete clinical remission after removal of ascites

A 58-year-old HIV-negative woman was admitted to our hospital with abdominal distension. She had a 5-year history of hypothyroidism and a 4-year history of diabetes mellitus. Physical examination revealed ascites. There was no lymphadenopathy or splenomegaly. Laboratory examination showed elevated levels of serum LDH and Al-p, polyclonal hypergammaglobulinemia, and was positive for anti-nuclear antibody, several autoantibodies and HCV-RNA. A computed tomographic scan of the abdomen and chest showed massive ascites, but there was no evidence of tumor masses or lymph node enlargement. Cytologic examination of the ascitic fluid revealed numerous abnormal lymphocytes which by flow cytometry demonstrated expression of CD5, CD19, CD20, and CD4. Cytogenetical analysis demonstrated a hyperdiploid karyotype, with numerical abnormalities. Southern blot analysis demonstrated rearranged monoclonal bands in JH and c-mycgenes. Polymerase chain reaction (PCR) analysis failed to detect the genomes of EBV and HHV-8 in the abnormal lymphocytes. A diagnosis of primary effusion lymphoma of B cell lineage was made. Following abdominal paracentesis, the patient remained in complete clinical remission for 7 months and died of an unrelated cause (cerebral bleeding). The present case demonstrated an HIV-, HHV-8-, and EBV-negative, and HCV-positive primary effusion lymphoma of B cell lineage, with a unique clinical course.     

Is segmentectomy with lymph node assessment an alternative to lobectomy for non-small cell lung cancer of 2 cm or smaller?

BACKGROUND: Lesser resection than the standard lobectomy for small-sized cT1N0M0 non-small cell lung cancers continues to be debated. METHODS: We reviewed specimens of 139 patients after lobectomy for cT1N0M0 cancer of 2 cm or less. In addition, we prospectively enrolled 70 patients able to tolerate a lobectomy, in a trial of lesser resection for these lesions. The limited procedure consisted of segmentectomy in which the resection line was delivered beyond the burdened segment, plus exploration of lymph nodes by frozen sectioning. This procedure was modified if the result was positive; this modified procedure was called extended segmentectomy. RESULTS: The nodal status after lobectomy was pN0, 107 patients; pN1, 12 patients; and pN2, 20 patients. Of the pN1 patients, 2 had only intralobar nodal involvement within the same segment of the main tumor. In the remaining 30 patients with nodal involvement, we ascertained the nodal involvement during the operation. Regarding intrapulmonary metastasis, 1 of 8 patients having this metastasis had the lesion at the segment where the main tumor was not located and had N2 disease, which was detected intraoperatively. If extended segmentectomy had been performed instead of lobectomy, the lesion could have been removed completely. The 5-year survival of patients with cT1N0M0 cancer of 2 cm or less was 87.3% after extended segmentectomy. There were no local recurrences and three noncancer-related deaths. Among patients with pT1N0M0 cancer of 2 cm or less, the 5-year survival was 87.1% in the extended segmentectomy group and 87.7% in the lobectomy group (p = 0.8008). CONCLUSIONS: Extended segmentectomy should be considered as an alternative for patients with cT1N0M0 non-small cell lung cancer of 2 cm or smaller.     

Cervical lymphnode metastasis of early or late T2 tongue carcinoma

Between 1986 and 1997, 72 patients (47 males, 25 females) with previously untreated tongue cancer were treated at our institution (surgery: 67, interstitial radiotherapy: 3, palliative therapy: 2). These patients, especially T2 tongue cancer, were classified into two groups (early T2: < or = 3 cm, late T2: > 3 cm) according to the maximum diameter of the primary lesion, and were analyzed for treatment outcome and cervical lymphnode metastasis. (1) The cumulative 5-year survival rates were 65.9% for all cases, 95.0% for T1 cases, 77.5% (94.1% for early T2, 59.7% for late T2) for T2 cases, 24.3% for T3 cases (4-year survival rate), and 0% for T4 cases. (2) The cumulative 5-year survival rates were 90.8% for pN- patients and 21.7% for pN+ patients and the difference was statistically significant (p < 0.05%). In prognosis, pN- patients were better than pN+ patients. Since the N factor was related to the cause of death in 87.5% (7/8) of T2 tongue cancer, control of regional lymph node involvement was the most important prognostic factor. (3) The overall incidence of cervical lymph node metastasis (pN+ or secondary nodal metastasis) was 35.3% for early T2 and 750% for late T2. The control rate of secondary nodal metastasis was 75.0% for early T2 and 33.3% for late T2. Partial glossectomy only (observation for occult lymphnode metastasis) is recommended for treatment of T2N0, whereas glossectomy with selective neck dissection by the pull-through method is recommended for treatment of late T2.     

A Novel Class of Antitumor Prodrug, 1-(2'-Oxopropyl)-5-fluorouracil (OFU001), That Releases 5-Fluorouracil upon Hypoxic Irradiation

We have been developing prodrugs of anticancer agents such as 5‐fluorouracil (5‐FU) that are activated by irradiation under hypoxic conditions via one‐electron reduction. Among them, OFU001 [1‐(2′‐oxopropyl)‐5‐fluorouracil] is a prototype radiation‐activated prodrug. In this study, we investigated the radiation chemical reactivity and the biological effects of OFU001. This prodrug is presumed to release 5‐FU through incorporation of hydrated electrons into the antibonding σ* orbital of the C(1′)‐N(1) bond. Hydrated electrons are active species derived from radiolysis of water, but are readily deactivated by O₂ into superoxide anion radicals () under conditions of aerobic irradiation. Therefore, 5‐FU release occurs highly specifically upon irradiation under hypoxic conditions. OFU001 dissolved in phosphate buffer released 5‐FU with a G‐value (mol number of molecules that are decomposed or produced by 1 J of absorbed radiation energy) of 1.9×10^?7 mol/ J following hypoxic irradiation, while the G‐value for 5‐FU release was 1.0×10^?8 mol/J following aerobic irradiation. However, the G‐values for decomposition of OFU001 were almost the same, i.e., 3.4×10^?7 mol/J following hypoxic irradiation and 2.5×10^?7 mol/J following aerobic irradiation. When hypoxically irradiated (7.5–30 Gy) OFU001 was added to murine SCCVII cells for 1–24 h, a significant cell‐killing effect was observed. The degree of this cytotoxicity was consistent with that of authentic 5‐FU at the corresponding concentrations. On the other hand, cytotoxicity was minimal when the cells were treated with aerobically irradiated or unirradiated OFU001. This compound had no radiosensitizing effect against SCCVII cells under either aerobic or hypoxic conditions when the drug was removed immediately after irradiation. Since hypoxia is generally most marked in tumors and irradiation is applied at the tumor site, this concept of prodrug design appears to be potentially useful for selective tumor treatment with minimal adverse effects of anticancer agents.     

Ca2+/CaM-sensitive adenylyl cyclase activity is decreased in the Alzheimer's brain: Possible relation to type I adenylyl cyclase

Summary Immunoreactivities of four subtypes of adenylyl cyclase (AC) (types I, II, IV and V/VI), and basal, forskolin- and Mn²⁺-stimulated AC activities with or without calcium and calmodulin (Ca²⁺/CaM) were estimated in parietal cortex membranes from cases with dementia of the Alzheimer type (DAT) and age-matched controls. Immunoreactivities of AC-I and AC-II were significantly decreased, but those of AC-IV and AC-V/VI did not change in DAT brains. There was a significant correlation of AC-I immunoreactivity with Ca²⁺/CaM-sensitive AC activity, but not with the Ca²⁺/CaM-insensitive activity. Ca²⁺/CaM-sensitive AC activity was significantly lower in DAT than in the control, indicating that impairment of Ca²⁺/CaM-sensitive AC-I is clearly involved in the pathophysiology of DAT.     

Infective endocarditis developing as uremia

A 49-year-old man presented with fever and uremic symptoms such as general malaise, leg edema and decreased urine output. He was diagnosed as having infective endocarditis (IE) accompanied by renal failure. Although he had been receiving hemodialysis for a long time, renal function dramatically improved after heart valve replacement. This case suggests that uremia can develop as an initial manifestation of IE and removal of an infected heart valve can improve renal function despite persistent renal failure. From the perspective of recovery of renal function, early surgery should be considered in patients with renal failure following IE.     

A comparison of perioperative factors with two methods of coronary artery bypass grafting (CABG): off-pump and conventional

BACKGROUND: The safety and efficiency of off-pump coronary artery bypass grafting (OPCAB) are still controversial. The purpose of this study was to evaluate this approach in comparison with the conventional cardiopulmonary bypass technique (cCABG). METHODS: A retrospective review of patients who had undergone coronary artery bypass grafting independently without other operations between January 1, 1999 and September 30, 2001 was performed. The patients were divided into two groups: those who underwent OPCAB and the remainder for cCABG. The perioperative factors of the two groups were compared. RESULTS: A total of 152 OPCAB and 142 cCABG cases were reviewed. Compared with cCABG, OPCAB significantly reduced the amount of catecholamine needed on admission to ICU, intubation time, overall hospital length of stay, and neurologic events. There were also trends for decreases in ICU length of stay, mortality, and renal failure. On the other hand, OPCAB did not affect perioperative blood loss. CONCLUSIONS: Overall OPCAB is safer and more efficient than cCABG. However, we have to note in anesthetic management that OPCAB does not reduce blood loss.