Prevalence of deep venous thrombosis in the lower limbs and the pelvis and pulmonary embolism in patients with positive antiphospholipid antibodies

BACKGROUND: Antiphospholipid antibodies (AA) are immunoglobulins that cross-react with phospholipid on cell membrane, and are therefore associated with a hypercoagulable state manifested by arterial/venous thromboses. We aimed to determine the prevalence of deep venous thrombosis in the lower limbs and the pelvic region (DVT) and pulmonary embolism (PE) in patients with positive AA. METHODS: Sixty-six patients (48 female, 18 male) with positive lupus anticoagulant (LA) and/or positive anticardiolipin antibody (aCL) underwent radionuclide (RN) venography with 370 MBq of 99mTc-MAA. Pulmonary perfusion scintigraphy was performed in 58 patients. Fifteen patients had positive LA and positive aCL (LA+/aCL+), 33 patients had positive LA only (LA+/ aCL-) and 18 patients had positive aCL only (LA-/aCL+). 43 patients were diagnosed with primary antiphospholipid syndrome (APS) and 19 were diagnosed with APS associated with SLE. RESULTS: DVT was detected in 21 of 66 patients (32%). Patients with LA+/aCL+ showed higher prevalence of DVT (53%) as compared to LA+/aCL- (27%) and LA-/aCL+ (22%). PE was found in 13 of 58 patients (22%). The prevalence of PE was higher in patients with positive aCL (33% in LA+/aCL+; 36% in LA-/aCL+) than in patients with negative aCL (10%). CONCLUSION: Because of the high prevalence of DVT and PE in patients with AA, RN scintigraphy must be recommended in screening for these clinical troubles. These results indicate that the prevalence of DVT and PE may vary in subgroups of AA.     

P16INK4Gene Mutations Are Relatively Frequent in Ampullary Carcinomas

A high incidence of gene mutations or deletions of P16INK4, a cell cycle regulator which inhibits the activity of cyclin-dependent kinase 4/cyclin D complex and blocks the Gl-to-S transition, has been reported in pancreato-biliary tract cancers. In order to investigate P16INK4 gene alterations in sporadic ampullary carcinomas, 17 sporadic ampullary carcinomas were examined. After histological diagnosis, DNA samples extracted separately from both cancerous and normal paraffin-embedded tissues were investigated. Loss of heterozygosity (LOH) was investigated utilizing 3 microsatellite markers on 9p21-22, and a mutationsl analysis was performed by cloning and sequencing. LOH was observed in 3 cases (17.6%) and somatic mutations with retention of heterozygosity were found in 7 cases (41.2%). Of note was that two mutations resulted in truncated incomplete proteins and one was a point mutation at the consensus site in the conserved ankyrin repeats, which would be crucial for function. Although two-hit inactivation was not evident in any of the mutation cases and further investigation would be needed to elucidate the role of altered p16INK4 , these results suggest that the pl6INK4 gene mutations are relatively frequent and its inactivation might be important in ampnllary carcinogenesis.     

Tumor promotion by fecapentaene-12 in a rat colon carcinogenesis model

Fecapentaenes are a group of fecal mutagens produced by anaerobicmicroflora of the colon. The potential of fecapentaene-12 (FP-12)to promote tumor development was tested in a rat colon carcinogenesismodel using N-methyl-N-nitrosourea (MNU) as the initiating agent.Two groups of female F-344 rats were initiated by intrarectalinstillations of MNU (2 mg in 0.5 ml H₂O, 3 times a week, for3 weeks; MNU and MNU + FP-12 groups). Two additional groups(FP-12 and Control) were given H₂O without carcinogen. In thepost-initiation phase, rats of the MNU + FP-12 and FP-12 groupswere intrarectally administered 400 ng of FP-12 in 0.5 ml T-Ebuffer, twice a week, for 24 weeks, whereas the MNU and Controlgroups received the vehicle only. Tumors were found only inthe MNU and MNU + FP-12 groups, their number being higher inthe latter. The number of carcinoma bearing rats as well asthe average number of carcinomas per rat were significantlyhigher (P< 0.05) in the MNU + FP-12 group as compared tothe MNU-alone values. Aberrant crypt foci (ACF) were found inall carcinogen-treated rats, including those that did not containtumors, whereas none were observed in the FP-12 and Controlgroups. The average number of ACF/cm² was also significantlyhigher in the MNU + FP-12 group, as was the case for the averagenumber of ACF containing >10 aberrant crypts per focus. Thesefindings suggest that FP-12 can express promoting activity inchemically induced colon carcinogenesis.     

The relationship of p53 Protein and lymph node metastases in invasive breast cancer

The p53 expression in invasive breast cancers from 106 patients was correlated with clinicopathological variables to ascertain its usefulness for estimating prognosis. The p53 expression was significantly associated with the number of axillary lymph node metastases and the presence of internal mammary lymph node metastases; however, it was not associated with age, menopausal status, histologic type, or tumor size. Although p53 expression was a significant prognostic factor according to univariate analysis, it did not appear to be an independent prognostic factor according to multivariate analysis. Thus, the prognostic power of p53 expression is likely to be weak and therefore probably of limited clinical value. Nevertheless, the number of patients in our study was small, and we believe that an investigation of a larger series of patients is indicated.     

Intramuscular myxoma with fibrous dysplasia: A report of two cases with a review of the literature

Two cases are reported of a rare association of intramuscular myxoma with fibrous dysplasia in a 70 and 40 year old Japanese woman, respectively. One of them had a solitary intramuscular myxoma, and the other patient suffered from two intramuscular tumors that had been initially misdiag-nosed as myxoid liposarcoma. Only 24 cases of this kind of association have been recorded in the literature. This association should be taken into consideration to avoid inappropriate treatment, when cases of myxoid soft tissue tumor with a bone lesion are encountered.     

Metastatic calcification: Accumulation of a bone tracer during dynamic data acquisition

Metastatic calcification is often detected by bone scintigraphy. We recently saw metastatic calcification in the stomach and kidneys of a patient on continuous ambulatory peritoneal dialysis. Tc-99m HMDP accumulation into both organs was noted even in the first frame of dynamic data acquisition of 4 min/frame, suggesting that calcium deposits may create an aggressive process and we may obtain information on the calcium deposit rate to better understand the mechanism of metastatic calcification.     

Effect of steroid on antiemetic for side effect of anticancer chemotherapy

The side effect of anticancer agents such as nausea and vomiting frequently interrupt chemotherapy. To reduce these side effects, 5-hydroxytryptamine (5-HT3) receptor antagonist or metoclopramide is administered combined with steroid. In this study, we examined the effect of 5-HT3 receptor antagonist on the frequency of nausea and vomiting in a male cancer patient treated with/without steroid. This patient in his sixties had esophageal cancer (stage IV). He was administered nedaplatin 100 mg/day for 1 day and then 5-fluorouracil (5-FU) 750 mg/day for 5 days combined with radiotherapy (60 Gy) as one cycle of this chemotherapy. In the first cycle, 5-HT3 receptor antagonist was administered, and in the second, the antagonist was administered after treatment with steroid. The blood levels of total bilirubin, GOT, GPT, BUN, Cre, Na, K and Cl were stable normally during both cycles of the chemotherapy, indicating that the hepatopathy and nephropathy which cause nausea and vomiting did not occur in these periods. The frequency and period of the nausea and vomiting were one-third decreased, respectively, by the combination of 5-HT3 receptor antagonist and steroid.     

A case of peritoneal dissemination disappeared by CPT-11 + TS-1 combination chemotherapy

A patient is a 35-year-old man. By a diagnosis of descending colon cancer, descending colon ablative operation and D1 lymph node dissection were performed on April 22, 2004. It was P3H0N1SE, Stage IV in perioperative findings. Abdominal CT showed peritoneal dissemination of 1.7 cm at the right under the abdominal wall wound and 1.2 cm in the rectovesical pouch on May 18, 2004. CPT-11 + TS-1 combination chemotherapy was started on June 22nd. In the five weeks of the combination chemotherapy, continuous infusion of CPT-11 (150 mg/body day 1 and 15) was twice administered, and oral administration of TS-1 (120 mg/body/day) was given for 3 weeks (day 1-21). Peritoneal dissemination disappeared after the two-course end, and we judged it as CR. Furthermore, we were certain that we obtained CR after the three course end. The adverse event was only neutropenia of grade 1. The fourth course was not administered, but recurrence has not been observed. Abdominal CT showed no recurrence on March 3, 2005 since the combination chemotherapy ended 6 months ago.     

Hand-assisted laparoscopic adrenalectomy to a solitary adrenal metastasis from lung cancer

A 75-year-old man with right chest pain was diagnosed with primary lung cancer in the right apical portion, and was treated with chemoradiotherapy because of a synchronous left adrenal tumor of 1.6 cm. Since the adrenal tumor did not increase in size for three months and there were no other relapses, the right upper lobectomy of the lung with the excision of the chest wall was performed. Afterward, an enlargement of the left adrenal tumor was encountered; he was admitted to our hospital for an operation. For the metastatic adrenal tumor from lung cancer, we performed a hand-assisted laparoscopic adrenalectomy. He recovered rapidly and returned to the previous hospital in two weeks after the operation. After the first report in 1992, the laparoscopic adrenalectomy has been established as the curative operation to adrenal benign tumor. The indication is being expanded to the malignancy because of the improvement of operation techniques and advancement of the operation equipments. We conclude that the laparoscopic adrenalectomy for malignant tumor is a safe, curative, and clinically useful surgical technique.