Liver disorder owing to estrogen therapy in prostatic cancer. The correlation between serum level of cholinesterase and dose of diethylstilbestrol diphosphate

We have examined the value of cholinesterase (ChE) that indicates the preservation ability of liver function, to assess the liver disorder owing to diethylstilbestrol diphosphate (DES-DP) administration in 25 prostatic cancer patients without castration. The correlation between ChE and the other factors such as age, total dose of DES-DP, duration of administration or ratio (total dose/duration), were studied by means of multiple regression analysis (MRA). In sixteen patients treated for less than 6 months, ChE was correlated with all factors by MRA with the coefficient of 0.645, and the coefficients of simple correlation between ChE and total dose and between ChE and administered duration, were -0.521 (p less than 0.05) and -0.596 (p less than 0.05), respectively. In nine patients treated for more than 6 months, ChE was correlated with all factors by MRA with the coefficient of 0.803, and the coefficient of simple correlation between ChE and ratio was -0.707 (p less than 0.05). According to these results and the permissible range of ChE, the total dose of administration for less than 6 months was estimated to be under 50 gram and its duration was within 100 days. The ratio in patients administered for more than 6 months was under 300 mg/day. Therefore, as far as the long-term hormonal treatment for prostatic cancer and preservation of liver function, we concluded that total dose of DES-DP should be less than 50 gram in less than 100 days for induction therapy and the daily dose of DES-DP should be less than 300 mg/day for maintenance therapy.     

Genetic polymorphisms of the interleukin-4 receptor alpha gene are associated with an increasing risk and a poor prognosis of sporadic renal cell carcinoma in a Japanese population.

PURPOSE: It has been suggested that the immune system of the host may be capable of modulating the clinical course of renal cell carcinoma (RCC) patients. In fact, the amount of Th2 cytokines such as interleukin (IL)-4 and IL-10 in the serum of patients has been found to be an important predictor of poor prognosis. Recently, it was reported that genetic polymorphisms of the IL-4 receptor alpha (IL-4Ralpha) gene affect the strength of signaling through the receptor. In addition, these same polymorphisms were found to be associated with an increased risk of atopy by causing Th2-dominated responses of the host. The significance of the polymorphisms on the incidence and prognosis in sporadic RCC patients were examined to clarify the role of IL-4 as well as that of the Th1/Th2 immune system in this disease. EXPERIMENTAL DESIGN: A case-control study was performed with 143 sporadic RCCs in a Japanese population and 205 Japanese controls. Logistic regression models were also used to assess the genetic effects on prognosis. RESULTS: The frequencies of variant alleles that enhance signaling of IL-4 were significantly related to an increased risk of RCC. Furthermore, multivariate regression analysis showed that the genotype of the IL-4R gene was an independent prognostic factor for cause-specific survival (P = 0.018) together with M classification (P = 0.0002) and histopathological grade (P = 0.044). CONCLUSIONS: The present findings show that the preferential Th2-type response to tumors was associated with a poorer prognosis and suggest that polymorphisms of the IL-4Ralpha gene may serve as useful genetic markers for assessing the risk of the development and progression of RCC.     

Corticosteroid-responsive parkinsonism associated with primary Sjögren's syndrome

A 74-year-old woman with primary Sjögren's syndrome confirmed by salivary gland biopsy presented with parkinsonism. Magnetic resonance imaging (MRI) of the brain revealed multiple small high intensity lesions in the deep white matter, basal ganglia and pons on T₂-weighted images. Treatment with -dopa failed to improve the parkinsonian features. After the initiation of prednisolone 30 mg/day, the parkinsonian signs and symptoms significantly improved. Some lesions on MRI were decreased in size after corticosteroid therapy. These findings suggest that parkinsonism associated with primary Sjögren's syndrome is at least in part attributable to small vessel vasculopathy such as focal inflammation or edema.     

Visual form agnosia in multiple sclerosis

We report a case of multiple sclerosis with visual form agnosia and callosal syndromes. Initially, the patient's visual recognition of object form was severely disturbed at the perceptual stage, in association with left-sided ideomotor apraxia and agraphia. Magnetic resonance imaging showed large white matter lesions in the bilateral frontal and occipital lobes, the latter extending to the occipitotemporal junction, and widespread corpus callosum lesions. Over the course of one year follow-up, neuropsychological examinations indicated that the patient's visual recognition defects occurred not only at the early substage of form perception, but also at the stage of reproducing the shape of objects from visual memory store. The present case suggests that neural connections between the striate cortex and occipitotemporal visual areas are crucial for both the perceptual and associative stages of visual object recognition.     

Placental yolk sac tumor with divergent endodermal differentiation.

We report an intraplacental germ cell tumor that was an incidental finding in the placenta of a 34-year-old woman. On pathologic examination, the 4.0-cm tumor was well circumscribed with a thin fibrous capsule. It exhibited three major histologic patterns within a mesenchyme-like myxoid background: a primitive endodermal component, a well-differentiated enteric glandular endodermal component, and a component of fetal hepatic tissue. The primitive endodermal component, the hepatic component, and many parts of the enteric endodermal glandular component were immunoreactive for alpha-fetoprotein. We considered the lesion to be a unique example of a placental yolk sac tumor and only the second reported case of a placental yolk sac tumor.