Involvement of the appendix in a relapsed case of primary nasal NK/T-cell lymphoma.

We report here a 20-year-old man presenting with primary nasal NK/T-cell lymphoma which showed an aggressive clinical course spreading to the spleen and skin despite various treatments. Eight months after high dose chemotherapy followed by autologous peripheral blood stem cell transplantation, acute appendicitis with perforation occurred and the patient underwent appendectomy. The histopathological diagnosis was NK/T-cell lymphoma of the appendix. Lymphoma of the appendix is extremely rare and the majority of appendiceal lymphomas are of B-cell origin. This is the first report of involvement of appendix by nasal NK/T-cell lymphoma.

Translocation (5;9)(q22;q34) in a case of acute lymphoblastic leukemia with multiple bone involvement: effectiveness of donor lymphocyte infusion for relapse after allogeneic stem cell transplantation.

A case of acute lymphoblastic leukemia with a new translocation, t(5;9)(q22;q34) is reported with special reference to the clinical features and the response to treatment. This case exhibited several unique clinical features, including expression of the myeloid antigen on the early pre-B-cell phenotype, multiple bone involvement, and favorable response to donor lymphocyte infusion despite early relapse after allogeneic hematopoietic stem cell transplantation.

Multiple lymphomatous polyposis overexpressing cyclin D1.

A case of mantle cell lymphoma (MCL) associated with multiple lymphomatous polyposis (MLP) is reported is a 62-year-old woman, with special reference to the patient's clinical features and response to treatment. There were multiple widespread polypoid lesions in the entire gastrointestinal tract, with ileocecal masses. Ileocecal resection was performed on immunohistochemical examination, the neoplastic cells in the polypoid lesions stained positively for cyclin D1. Two conventional anthracycline-containing regimens (adriamycin-cyclophosphamide-vincristine-prednisolone [CHOP] and mitantroxone-etoposide-vindesine-prednisolone [MEVP]) were administered, but had limited success. The patient has since been receiving an irinotecan-adriamycin regimen (irinotecan, 25 mg/m(2), days 1 and 2; adriamycin, 40 mg/m(2), day 3, once a month) as an outpatient and has achieved good partial remission. She is well with disease 48 months after the initiation of the initial treatment.

Effects of dissolved oxygen on the morphology of an arachidonic acid production by Mortierella alpina 1S-4.

Arachidonic acid (AA) production by Mortierella alpina 1S-4 was investigated using a 50-L fermentor. In order to optimize the dissolved oxygen (DO) concentration and to investigate the effect of DO on morphology, cultivation was carried out under constant DO at various levels in the range of 3-50 ppm. To maintain a DO concentration above 7 ppm, two methods, i.e., the oxygen-enrichment (OE) method (experimental range, 25-90% oxygen gas supplied) and the pressurization (PR) method (experimental range, 180-380 kPa headspace pressure), were used. As a result, the optimum DO concentration range was found to be 10-15 ppm. In this optimum DO concentration range, the AA yield was enhanced about 1.6-fold compared to that obtained at 7 ppm DO, and there was no difference in the AA productivity between the OE and PR methods. When the DO concentration was maintained at 20-50 ppm using the OE method, the morphology changed from filaments to pellets, and the AA yield decreased drastically because of stress due to the limited mass transfer through the pellet wall. When the DO concentration was maintained at 15-20 ppm using the PR method, the morphology did not change, and the AA yield decreased gradually.

[Successful treatment with CPT-11 and adriamycin for hemophagocytic syndrome associated with intravascular lymphomatosis].

A 75-year-old man was admitted because of non-Hodgkin's lymphoma (histology undetermined) of the rib. A complete remission was achieved after CHOP therapy and irradiation. One year later, high fever, thrombocytopenia and liver dysfunction developed. Bone marrow aspirate revealed a hypoplastic marrow with hemophagocytic histiocytes, and a diagnosis of hemophagocytic syndrome (HPS) was made. Although no lymphomatous lesions were detected, HPS due to relapsed lymphoma was strongly suspected. The patient received MEVP therapy including etoposide and prednisolone, but without any improvement. Soon after the initiation of CPT-11 and adriamycin (ADM) therapy, all symptoms of HPS disappeared. This combination chemotherapy was repeated over a three-week span, and the patient remained in partial remission for the next 10 months. In November 1997, a tumor developed in the paranasal sinus, and the patient died three months later. The autopsy disclosed many B lymphoma cells filling the small vessels of almost all organs, and a final diagnosis of intravascular lymphomatosis (IVL) was made. These findings indicate that combination CPT-11 and ADM therapy is effective for cases of IVL accompanied by HPS that are refractory to conventional chemotherapies.

Significance of parathyroid hormone-related protein as a factor stimulating bone resorption and causing hypercalcemia in myeloma.

Elevated levels of parathyroid hormone-related protein (PTHrP) in hypercalcemic myeloma patients were demonstrated in recent reports, suggesting that PTHrP behaves as a humoral mediator of hypercalcemia in myeloma. Herein we describe a hypercalcemic myeloma patient with a high serum PTHrP level. Moreover, the PTHrP level in the supernatant of bone marrow aspirates was about two-fold of that in serum. Reverve transcriptase-polymerase chain reaction analysis showed PTHrP m-RNA in bone marrow containing myeloma cells. After chemotherapy, the concentrations of calcium and PTHrP decreased and PTHrP mRNA in bone marrow became undetectable. We conclude that PTHrP released by myeloma cells acted as the main bone resorption stimulating factor in this case.

[Two patients with acute promyelocytic leukemia whose relapse was noted by cytodiagnosis of middle ear discharge].

Patient 1 was a 36-year-old male and diagnosed as APL in April 1989, and treated with BHAC-DMP and BHAC-AMP. In January 1990, a diagnosis of exudative otitis media was made, but intractable. In June, left facial paralysis appeared and cytodiagnosis of the discharge from the middle ear confirmed leukemic cells. Otitis media and facial paralysis improved after high dose Ara-C, but developed again 5 months later. The condition improved after high dose Ara-C and irradiation of the temporal bones. In September 1992, he died of recurrence but no aggravation in facial paralysis or otitis media. Patient 2 was a 24-year-old female and diagnosed as APL in July 1989, and treated with BHAC-DMP. In May 1990, exudative otitis media was appeared. In July, recurrence was observed but improved by high dose Ara-C. In October, otitis media was aggravated again, and cytodiagnosis confirmed leukemic cell infiltration. She was treated with high dose Ara-C and irradiation of the temporal bones, then achieved complete remission. Maintenance therapy was continued until August 1992, she has been alive. When exudative otitis media developed during the course of leukemia, cytodiagnosis of the discharge from the middle ear should be performed. High dose Ara-C and irradiation of the temporal bone were effective.

Tissue-specific expression of the gene for a putative plasma membrane H(+)-ATPase in a seagrass.

A cDNA clone corresponding to the gene (ZHA1) for a putative plasma membrane H(+)-ATPase of a seagrass (Zostera marina L.) was isolated and sequenced. Comparison of the amino acid predicted sequence from the nucleotide sequence of ZHA1 with those encoded by known genes for plasma membrane H(+)-ATPases from other plants indicated that ZHA1 is most similar to the gene (PMA4) for a plasma membrane H(+)-ATPase in a tobacco (84.4%). Northern hybridization indicated that ZHA1 was strongly expressed in mature leaves, which are exposed to seawater and have the ability of tolerate salinity; ZHA1 was weakly expressed in immature leaves, which are protected from seawater by tightly enveloping sheaths and are sensitive to salinity. In mature leaves, in situ hybridization revealed that ZHA1 was expressed specifically in epidermal cells, the plasma membranes of which were highly invaginated and morphologically similar to those of typical transfer cells. Therefore, the differentiation of the transfer cell-like structures, accompanied by the high-level expression of ZHA1, in the epidermal cells of mature leaves in particular may be important for the excretion of salt by these cells.

Neoadjuvant intra-arterial doxorubicin chemotherapy in combination with low dose radiotherapy for the treatment of locally advanced transitional cell carcinoma of the bladder.

Between 1979 and 1990, 60 patients with locally advanced bladder cancer (stages T2 to 4NXM0) were treated with intra-arterial doxorubicin chemotherapy in combination with low dose radiotherapy and 36 (60%) achieved a complete remission. The tumor size (p < 0.01), tumor grade (p < 0.05) and clinical stage (p < 0.05) correlated significantly with the tumor response to the combined therapy. Of the 36 patients with complete remission and the 24 patients who did not achieve a complete remission 35 and 22, respectively, underwent a conservative bladder operation after treatment. Median followup was 71 months. The overall 5-year disease-free and cause-specific survival rates for the 60 patients were 49% and 72%, respectively. A significantly higher (p < 0.01) 5-year survival rate was observed in patients who achieved a complete remission (94%) than in those who did not (40%). The results suggest that intra-arterial chemotherapy plus radiotherapy is a useful regimen for patients with locally advanced bladder cancer, and bladder function may be preserved in those who achieve a complete remission.

Optimization and simulation of continuous affinity-recycle extraction (care).

Simulation and optimization of continuous affinity recycle extraction (CARE), a protein purification unit operation based on protein adsorption to solid phase adsorbents, is described in this paper. Rather than packing conventional adsorbent particles in a fixed bed (column), solid/liquid contact is carried out in well-mixed reactors. Continuous operation is achieved by recirculation of the adsorbent particles between two or more contactors. The feasibility of this purification scheme was established with the recovery and isolation of the enzyme beta-galactosidase from E.coli, using the affinity support PABTG/Agarose. A mathematical model describing system performance was developed. The mathematical model was used to optimize several facets of the system design and operation. The base two-stage contractor design was modified by the addition of an intermediate wash stage as well as the incorporation of multiple adsorption stages. These design modifications serve to increase purification, concentration and recovery while utilizing the same amount of adsorbent. The methodology for defining and optimizing objective functions was developed and experimentally validated. Finally, optimum system start-up protocols, minimizing the time required to reach steady-state operation, were developed and experimentally validated. The impact of early introduction of adsorptive purification in a downstream processing sequence, with CARE, was evaluated and is described. Through the early introduction of a highly specific adsorptive step, significant purification is achieved simultaneously with clarification and concentration. In addition, purification performance in CARE was contrasted with that achievable in conventional column chromatography.

[A clinicopathological study on tumor of the renal pelvis and ureter].

We report 42 patients with urothelial tumors in upper tract admitted to our hospital between August, 1969 and August, 1988. The patients consisted of 33 males and 9 females; their ages ranged from 42 to 85 years with a mean of 66.2 years. Total nephroureterectomy with bladder cuff resection was employed as the surgical method in 24 cases, total nephroureterectomy without bladder cuff resection in 11 cases, total nephroureterectomy with total cystectomy in 2 cases and partial ureterectomy only in 2 cases. Tumor lesions had a positive correlation with grade and stage. The survival rate for all the patients at 1, 3 and 5 years was 76.0, 58.8 and 54.6%, respectively, as measured by the Kaplan-Meier's method. The prognosis of the patients with renal pelvic tumor and ureter tumor was dependent upon grade, stage and intravascular tumor-emboli. Vesical recurrence was observed in 10 cases and found frequently in low grade tumor and/or low stage tumor cases. The frequency of vesical recurrence was not positively correlated with cuff resection The 5-year survival rate was not different between the patients with vesical recurrence and those without vesical recurrence.

[Clinical studies on cases of suprapubic prostatectomy].

The results of the operation were analyzed statistically in 68 patients who underwent suprapubic prostatectomy for benign prostatic hypertrophy from 1979 to 1985. The patients were between 59 and 86 years old with a mean age of 72.0 years. The average operation time was 63 minutes and average blood loss during the operation was 292 g. The average weight of enucleated prostate was 32.6 g. Acute epididymitis and urine leakage from the wound were the most frequent postoperative complications. There were no postoperative deaths. The average postoperative admission period was 25.6 days. Histological examination of the specimens revealed occult carcinoma in 2.9% of the patients.

[Clinicopathological observation on renal cell carcinoma. "The relationship between the histological and clinical findings"].

The relationship between the histological and clinical findings of 128 cases of renal cell carcinoma operated on during the past 17 years were analyzed. With elevation of tumor grading, the elevated ESR and CRP-positive cases were increased with a significant difference. The serum alpha 2-globulin was elevated in the grade 3 group significantly, but not in the grade 1 or 2 group. Seven of the eight spindle cell type cases showed an elevation of ESR, CRP-positive and an elevation of alpha 2-globulin. There was no difference in clinical findings between well circumscribed border and poorly demarcated margin. A high percentage of quick type cases of renal cell carcinoma were found in high grade cases with a significant difference.