Lennert's lymphoma: a variant of cytotoxic T-cell lymphoma?

We studied 10 cases of Lennert's lymphoma (lymphoepithelioid lymphoma) to evaluate the cellular origin of the neoplastic cells. There were six men and four women, aged 38 to 75 years (median, 56 yrs; mean, 59 yrs). The lymphoma cells tended to remain confined to lymph nodes, and extranodal involvement was rare. The mean overall survival was 42.2 months, which is relatively good compared with other peripheral T-cell lymphomas. Morphologically, the lymph node was occupied by small to large clusters of epithelioid cells interspersed with medium to large atypical lymphoid cells. In seven cases, large atypical lymphoid cells resembling Hodgkin's or Reed-Sternberg cells were observed. The phenotypes of these neoplastic cells were CD3+ CD4- CD8+ in five cases, CD3+ CD4+ CD8- in four cases, and CD3+ CD4- CD8- in one case. TIA-1 was positive by immunohistochemical staining in seven cases, whereas four cases were positive for granzyme B. Clonal rearrangement of the T-cell receptor gene was confirmed in all cases by either Southern blot hybridization or a polymerase chain reaction-based denature gradient gel electrophoresis method. Epstein-Barr virus was negative by in situ hybridization in all but one case. Lennert's lymphoma was formerly known as a CD4+ helper T-cell neoplasm. Our results suggest that, at least in some cases, the neoplastic cells are of cytotoxic T-cell origin.     

p16/MTS1/INK4A gene is frequently inactivated by hypermethylation in childhood acute lymphoblastic leukemia with 11q23 translocation.

The p16 gene encoding a specific inhibitor of cyclin-dependent kinases 4 and 6 has been reported to be inactivated at a variety of rates in malignant tumors. We studied frequency and mechanism of inactivation of the p16 gene in various types of childhood acute lymphoblastic leukemia (ALL) using 36 leukemic cell lines established from children (B precursor-ALL, 28; B-ALL/Burkitt's lymphoma, 3; and T-ALL, 5). On Southern blot, homozygous deletions or hemizygous deletions with rearrangement were detected in 14 cell lines. The expression of p16 protein was not observed on Western blot in 18 of 22 cell lines with intact p16 gene, but induced in 16 cell lines after treatment with the demethylating agent, indicating the silencing of the p16 gene by hypermethylation. Of note, the p16 gene was inactivated by hypermethylation of the 5' CpG island in nine of nine cell lines with 11q23 translocation, but was restored with the treatment of the demethylating agent. Partial methylation of the p16 gene was also demonstrated in three of eight primary leukemia samples with this translocation, suggesting that the p16 gene inactivation by hypermethylation might play a role in the leukemogenesis and disease progression of ALL with 11q23 translocation.     

Fractionated stereotactic radiotherapy of small intracranial malignancies

Purpose: To retrospectively evaluate the effectiveness of fractionated stereotactic radiotherapy (FSRT) in patients with small intracranial malignancies.

Methods and Materials: From July 1991 to March 1997, 80 patients with a total of 121 brain or skull-base tumors were treated with FSRT alone, and were followed for periods ranging from 3 to 62 months (median 9.8). The majority of patients received 42 Gy in 7 fractions over 2.3 weeks, but in July 1993, protocols using smaller fraction doses were introduced for patients whose radiation-field diameters were larger than 3 cm or whose tumors were close to critical normal tissues.

Results: For 64 patients with metastatic brain tumors the overall median survival was 8.3 months and 1-year actuarial survival rate was 33%. Significant prognostic factors were: the presence of extracranial tumors, pre-treatment performance status, and the lung as a primary site. Patients without extracranial tumors prior to FSRT had a median survival of 21.2 months. For seven patients with high-grade glioma, 1-year actuarial local control rate was 75%, with a median survival of 10.3 months. For patients with skull-base tumors the local control was achieved in 6 of 6 patients (100%), with a median survival of 30.7 months. No one suffered from acute complications, but three patients, two of whom had undergone FSRT as the third course of radiotherapy, developed late radiation injuries.

Conclusion: Overall high local control and low morbidity rates suggest that FSRT is an effective and safe modality, even for those with a history of prior irradiation. However, patients with risk factors should be treated with smaller fraction doses.     

Construction and delivery of tissue-engineered human retinal pigment epithelial cell sheets, using magnetite nanoparticles and magnetic force

Choroidal neovascularization (CNV) is the most severe form of age-related macular degeneration (AMD), which causes rapid visual loss. Transplantation of cultured retinal pigment epithelium (RPE) cell sheet by tissue engineering is a possible approach to the treatment of CNV. In the present study, we investigated the possibility of using magnetite nanoparticles and magnetic force to construct and deliver RPE cell sheets in vitro. When magnetite cationic liposomes (MCLs), having a positive charge at the surface, were added to ARPE-19 human RPE cells at a concentration of 25 or 50 pg of magnetite per cell, the cells took up 40 to 55% of the MCLs. The magnetically labeled ARPE-19 cells (8 x 10(3) cells/mm(2), which corresponds to 10-fold the confluent concentration against the culture area [4 mm(2)]) were seeded into an ultra-low-attachment plate and a magnet (4000 G) was placed under the well. The magnetically labeled ARPE-19 cells formed an approximately 15-layered cell sheet after a 24 h of culture. When the magnet was removed, the sheets were detached from the bottom of the plate and then harvested and transferred to a tissue culture dish, using a magnet. Subsequently, the cell sheets were attached onto the dish, and the cells growing on the sheets were observed. This novel methodology, termed "magnetic force-based tissue engineering" (Mag-TE), is a possible approach for CNV treatment.     

Radiological imaging change in a malignant bowel obstruction patient treated with octreotide

Introduction  Malignant bowel obstruction (MBO) is a complication in advanced cancer patients with abdominal and pelvic malignancy. Recent research has established the efficacy of octreotide for MBO-related symptom relief. The mechanism that octreotide increases water absorption in case of MBO has not been demonstrated except for experimental animal and normal human model. Case report  We present a 60-year-old man with pancreatic cancer and MBO treated with octreotide. Radiological imaging showed the disappearance of large-volume fluid retention in the small intestine with alleviating vomiting within 2 days. This radiological change might result from the effect of octreotide increasing water absorption in intestine tract.     

Somatosensory evoked potentials in attention deficit/hyperactivity disorder and tic disorder.

OBJECTIVE: Both attention deficit/hyperactivity disorder (ADHD) and chronic tic disorder (TD) are hyperkinetic disorders. These disorders often coexist with each other and frequently have sensory components. Therefore, we hypothesized that they might have a common pathophysiology involving the somatosensory system, especially hyper-excitabilities of primary somatosensory area. METHODS: To evaluate sensory system excitability, we examined somatosensory evoked potentials (SEP) elicited by median nerve stimulation in 18 children with ADHD and 18 children with TD. RESULTS: Three children with ADHD and 8 children with TD showed giant SEP and the peak-to-peak amplitude for N20-P25 was also significantly greater than that obtained from normally developing children (P<0.05 for ADHD and P<0.01 for TD). Children with TD had significant left-ward asymmetry of N20-P25 (P<0.01) and higher left-hemispheric N20-P25 than children with ADHD (P<0.05). CONCLUSIONS: Although hyper-excitability of the primary somatosensory area is a common characteristic for ADHD and TD, its severity, especially in the left-hemisphere, differs (i.e. TD has left-ward hyper-excitability). SIGNIFICANCE: The possibility remains that hyper-excitability of the primary somatosensory area is a reason why these disorders often coexist with each other and left-ward hyper-excitability of the primary somatosensory area is a unique feature of TD described for the first time.     

Chronotherapy of bronchial asthma: circadian rhythms in peak expiratory flow. The report II: Circadian rhythms of peak expiratory flow in asthmatic patients and effect of sustained-release theophylline on various types of the circadian rhythms]

We monitored peak expiratory flow (PEF) in outpatients with adult bronchial asthma in 17 sites in Chiba prefecture 4 times daily for 2 weeks, using a peak flow meter to categorize the patients by circadian patterns of PEF. Then a sustained-release theophylline preparation formulated for once-daily dosing was administered to these patients grouped to examine the effect of the drug on circadian rhythms in PEF. Analysis was performed in 215 of total 245 patients enrolled as a result of excluding 30 ineligible patients. 187 patients (87.0%) exhibited a certain rhythm in their PEF, and 28 patients (13.0%) did not show any particular rhythm. These 187 patients with a certain rhythm in PEF were grouped into 63 patients (29.3%) of morning-dip type, 83 patients (38.6%) of peak type, 7 patients (3.3%) of evening-dip type, and 34 patients (15.8%) of flat type. And there were no trough-type patients. Uniphyl tablets were administered once a day at a daily dosage of 400 mg after supper to 124 patients of the above 187 patients grouped according to circadian patterns of PEF. Uniphyl was particularly effective in the morning-dip type and the peak type. This result suggests that it is necessary to take circadian rhythms of PEF into consideration in drug therapy for patients with bronchial asthma.