Congenital prepubic sinus: A variant of dorsal urethral duplication (Stephens type 3)

Abstract A 3-year-old boy was admitted for yellowish discharge from a tiny opening in the midline prepubic area on the dorsal base of the penis. No other symptom related to the genitourinary tract was noted. Sinuousgraphy showed a non-communicating sinus tract with the urinary tract. At surgical exploration, through a diamond-shaped incision, a 4.5 cm-long sinus was found that ended blindly as a fibrous cord at the anterior surface of the pubic symphisis. Histologically, it was lined by stratified squamous epithelium and surrounded by bundles of smooth muscle and collagen. According to Stephens' classification, the sinus appears to be a variant of dorsal urethral duplication of Stephens type 3.     

Point mutations in the c-K-ras 2 gene in multiple colorectal carcinomas

Abstract The c-K-ras 2 gene mutations were examined in colorectal tumours from patients with synchronous or metachronous tumours in order to investigate tumorigenesis. Sixty-seven colorectal carcinomas from patients with a single lesion, 50 from patients with synchronous lesions, and 12 from patients with metachronous lesions were analysed for the presence of point mutations in codons 12 and 13 of c-K-ras proto-oncogene. In the patients with metachronous or synchronous lesions, the finding of the mutation in one tumour was not associated with a greater frequency of the mutation in other carcinomas from the same patient. In the patients with tumours that each contained the mutation, the mutations were not always the same. In tumours from the patients with original and synchronous lesions, the mutation frequency was significantly lower in advanced carcinomas invading through the entire muscularis propria (10.5%) than in early carcinomas confined to the mucosa (47.8%), and the mutation frequency in carcinomas invading through the entire muscularis propria was significantly lower in patients with synchronous lesions (10.5%) than in patients with a single lesion (37.7%). These results suggest that the tumorigenesis of colorectal carcinomas from patients with synchronous lesions is different from that in patients with a single lesion.     

BCG Immunotherapy as an Adjuvant to Surgery in Lung Cancer: A Randomized Prospective Clinical Trial

A protocol was drawn up and a prospective randomized study wascarried out to test the effectiveness of BCG on lung cancer.BCG obtained from the Japan BCG Institute was used. A dose of5.4 mg or 2–4 x 10⁸ viable organisms was administeredinto the arm by the tine technique. Administration of BCG wascarried out once before surgery and four times after surgery.Surgery consisted basically of radical lobectomy or pneumonectomywith complete mediastinal lymphadenectomy. The survival rate in the BCG administered group was significantly(P < 0.05) more than in the control group. Further, whenonly the cases that were treated strictly in accordance withthe protocol were taken into consideration, the effectivenessof BCG was even more significant (P < 0.02). The period ofobservation of these cases was from a minimum of 10 months toa maximum of 28 months. On the basis of these results, it can be said that BCG is beneficialin the treatment of lung cancer.     

A Case of Early Rectal Cancer (Mucosal Cancer) with Pulmonary Metastasis Detected by Postoperative Rise of Carcinoembryonic Antigen

Polypectomy was conducted under rectoscopic observation fora patient with a small rectal polypoid cancer (mucosal cancer)on an outpatient treatment basis. The serum carcinoembryonicantigen (CEA) level, which had been high before the polypectomy,was reduced and complete cure seemed to have been attained.However, the postoperative serum CEA level at the patient'speriodical check-up proved to be abnormally high, and a closerexamination revealed a small pulmonary metastasis. Eight monthsafter the polypectomy, the metastatic focus in the lung wasresected curatively and the serum CEA level returned to normal.It was verified by immunofluorescence that the tissues in themetastatic focus were CEA-productive. As the pulmonary metastasis, which is extremely rare in thecases of early cancers, could be detected at its early stageby the periodical check of the serum CEA level, and as the serumCEA level could be returned to normal by resection of the metastaticfocus, it was thought that the resection was curative.     

Assessment of variables affecting flow propagation velocity of the left ventricle in healthy children

BACKGROUND: The purpose of the present study was to establish the normal values of flow propagation velocity (FPV) in healthy children and examine the variables that affect FPV in clinical situations. METHODS: Two hundred and thirty- five healthy children and adolescents were assessed (aged 0-22.6 years, mean age 7.4 +/- 5.4 years; male, n = 142; female, n = 93). FPV was obtained from an apical four-chamber view and determined as the slope of aliasing velocity of early diastolic transmitral flow on the color M-mode using Aloka SSD-5500 with 5.0 MHz transducer. Aliasing velocity was set at 50-70% of the peak transmitral flow velocity. Peak transmitral flow velocities in early diastole (E) and during atrial contraction (A), and the ratio of early to late peak velocity (E/A) were obtained. Tei index was also measured for analysis of general left ventricular performance. Left ventricular mass index (LVMI) was obtained from conventional echo measurement. E, E/A, Tei index and LVMI were compared with FPV in healthy subjects. RESULTS: FPV obtained from all subjects ranged from 23.7 to 96.0 cm/s (61.3 +/- 13.6 cm/s). Normal value of FPV was less dependent on age, body size, heart rate and left ventricular dimension. In contrast, although there was no significant correlation between FPV and ejection fraction, statistically significant correlation was found between FPV, LVMI (P = 0.0008) and Tei index (P = 0.025). CONCLUSIONS: FPV is independent of age, body size and heart rate and is useful to assess left ventricular relaxation in children.     

Sphincter-Saving Reconstruction for Radiation-Injured Rectum: A Report of Four Cases with Special Reference to the Pull-Through Procedure

Up to now sigmoid colostomy has been a widely accepted and conventionaltreatment for the radiation-injured rectum, but patients withoutresidual malignancy strongly desire to live without a colostomy.We have tried to remove the involved rectal segments by sphincter-savingprocedures. Four patients underwent these procedures, pull-throughprocedure in three and low anterior resection in one. Amongsphincter-saving procedures, the pull-through procedure wasthe most adequate. Provided the following five conditions are fulfilled, the pull-throughprocedure should be considered for the severely radiation-injuredrectum.

1. No recurrence of the initial malignancy in the pelvis.
2. Preferably,a more than 2 cm intact rectal segment above thedentate linepreserved.
3. No radiation-injured segment in the upper sigmoid.
4. No severe radiation damage in the small intestine.
5. Normalanal function.

     

Antitumor Effect of 3-[(4-Amino-2-Methyl-5-Pyrimidinyl) Methyl]-1-(2-Chloroethyl)-1-Nitrosourea (ACNU) on Human Colon Carcinomas Transplanted into Nude Mice

Two human colon carcinomas serially transplanted into nude micewere used for experimental chemotherapy by 3-[(4-amino-2-methyl-5-pyrimidinyl)methyl]-1-(2-chloroethyl)-1-nitrosourea(ACNU). Human colon carcinomas Co-3 (well-differentiated adenocarcinoma)and Co-4 (poorly differentiated adenocarcinoma), were transplantedsubcutaneously into the backs of BALB/c male nude mice. Tumorsize was measured three times a week, and treatment was startedwhen the estimated tumor weight reached 100 to 300 mg. Twentyand 40 mg of ACNU per kg was administered intravenously, once,dissolved in 0.2 ml of normal saline. There were marked tumorregression and histological tumor cell destruction in Co-4,whereas no effect was observed in Co-3. Microangiography revealed a similar vascular network in Co-3and Co-4. Whole-body autoradiography was performed 5, 30, 180and 360 minutes after 20 mg (286 µC₁) of [ethylene-2-¹⁴C]-ACNUper kg was injected. ACNU concentration in the Co-3 tumor reacheda peak 30 minutes after injection and diminished promptly withthe decrease of ACNU in the blood, whereas in Co-4 tumors ACNUwas retained in the tumor until 360 minutes after ad ministration.The effect of ACNU was thought to be correlated with the concentrationof the drug in the tumor. Present address: Department of Surgery, Kitasato InstituteHospital, Tokyo, Japan.     

Impact of thrombocytosis and C-reactive protein elevation on the prognosis for patients with renal cell carcinoma

AIM: C-reactive protein (CRP) elevation is reportedly a prognostic factor in patients with renal cell carcinoma (RCC). Thrombocytosis has recently been reported also to be a prognostic factor in RCC and, like CRP, to be related to inflammatory cytokines such as interleukin-6. The aim of this study was to evaluate the importance of both thrombocytosis and CRP elevation in tumor recurrence and prognosis for patients with RCC. METHODS: The clinical records of 178 patients who underwent radical nephrectomy were reviewed. Thrombocytosis was defined as a platelet count >or=350,000/mm(3), and CRP elevation was defined as a CRP level >or=1.0 mg/dL. Disease-free survival and cause-specific survival rates were calculated. Independent predictors for recurrence and prognosis were determined. RESULTS: Patients with thrombocytosis and patients with elevated CRP levels had significantly higher pathological T stage, clinical stage, tumor size, histological grade, and percentage of microvascular invasion than did patients without THC and patients with CRP levels <1.0 mg/dL, respectively. There was a significant correlation between platelet counts and CRP levels. Multivariate analysis showed that distant metastasis, tumor size, grade 3 components, and CRP elevation were independent predictors for prognosis but thrombocytosis was not. In N0M0 RCC patients, tumor size, microvascular invasion, and CRP elevation were independent predictors for recurrence. CRP elevation and tumor size were independent predictors for prognosis. CONCLUSIONS: Platelet count and CRP level are strongly correlated in patients with RCC, but only CRP elevation is an independent predictor for recurrence and prognosis.     

Clinical and biological aspects of acute lymphoblastic leukemia in 62 infants: Retrospective analysis of the Tokyo Children's Cancer Study Group

BACKGROUND: As a first step to formulate a new treatment strategy for refractory acute lymphoblastic leukemia (ALL) in infants, clinical results and immunophenotypic and cytogenetic data were analyzed and compared with those from overseas. METHODS: There were 62 infants with ALL who were treated between 1977 and 1995 at 30 institutions affiliated with the Tokyo Children's Cancer Study Group. Clinical and laboratory data obtained from these infants (all under 1 year of age) were retrospectively studied. RESULTS: The morphological diagnoses were FAB-L1 for 51 patients (82.2%) and FAB-L2 for 11 patients (17.8%). Hepatomegaly and splenomegaly were found in 40 (70.0%) and 40 patients (68.3%), respectively. The mean (+/- SEM) leukocyte count at diagnosis was 205,900 +/- 35,700/microL. The involvement of the central nervous system was evident in nine of 36 patients who were subjected to lumbar puncture, while three of these nine patients were free of neurological symptoms at diagnosis. Thirty-one patients (55.4%) were CD10 negative and 14 (25.0%) were CD10 positive. Thirty-one of 47 patients (65.9%) exhibited chromosomal abnormalities, including 28 patients (59.6%) with 11q23 abnormalities. Rearrangements in the MLL gene were found in nine of 13 infants (69.2%) examined. Translocation of 11q23 and/or MLL gene rearrangement (11q23/MLL) was significantly associated with the absence of the CD10 antigen. Hyperleukocytosis of more than 50,000/microL and 11q23/MLL gene rearrangements were related to a poor prognosis. The probability of an event-free survival in 62 infants was 13.1 +/- 4.8% at 48 months. CONCLUSIONS: New therapeutic strategies and large-scale cooperative prospective trials are needed to improve the prognosis of ALL in infants.