Loss of heterozygosity at the DCC gene locus is not crucial for the acquisition of metastatic potential in oesophageal squamous cell carcinoma.

Tumour specimens from 111 patients with oesophageal squamous cell carcinoma were screened for loss of heterozygosity (LOH) at the deleted colorectal carcinoma (DCC) gene locus. DCC-LOH occurred in 10 of 61 informative cases (16%). No statistically significant correlation was observed between DCC-LOH and lymph node metastasis, histopathological grade or tumour stage. The survival of patients exhibiting DCC-LOH was not statistically different from that of patients without LOH. These results suggest that LOH at the DCC locus is not related to the acquisition of metastatic potential or the state of tumour cell differentiation in oesophageal squamous cell carcinoma.

Metachronous development of malignant Leydig cell tumor.

Leydig cell tumor (LCT), a rare testicular tumor, is malignant in only about 10% of the cases. We report the case of a patient with bilateral malignant LCTs that developed metachronously. After undergoing a right inguinal orchiectomy for a malignant LCT at the age of 43 years, the patient was given cisplatin-based chemotherapy for suspected para-aortic lymph node metastasis. Eighteen months after the right orchiectomy, examination of a left testicular biopsy specimen showed a malignant LCT and a left inguinal orchiectomy was performed. Histologically, the initial malignant LCT exhibited a highly pleomorphic appearance with mitotic figures (58/10 HPF), whereas the second malignant LCT showed fewer mitoses (2/10 HPF). The proliferating cell nuclear antigen (PCNA)-labelling index in these tumors also differed (right-sided tumor, 50%; left-sided tumor, 28%). These findings suggest that the malignant LCT in the left testis developed as a second primary rather than as a metastatic tumor. There have been no known similar cases, although three cases of malignant LCT with contralateral metastasis have been reported.

[A case of clivus chordoma showing hemorrhage in the posterior fossa].

We are reporting a rare case of clivus chordoma with fatal hemorrhage in the posterior fossa. A 38-year-old woman afflicted with sudden onset of severe headache and vomiting. On neurological examination, she was mildly lethargic. She had slight dysarthria and nystagmus, but no cranial nerve abnormalities. Craniogram revealed erosive changes in the right petrous bone. CT scan showed a massive intracerebellar hemorrhage and isodense mass in the sphenoid sinus, which were not enhanced by contrast medium. She became comatose and died 3 days later. No operation was performed. Autopsy revealed massive hemorrhage in the posterior fossa and yellowish, gelatinous tumor extending from the right clivus to the sphenoid sinus. Histological examination showed a chordoma. This case demonstrates that the hemorrhage associated with brain tumor, especially in posterior fossa, produces a significant sudden elevation of intracranial pressure and leads clinically to a rapid loss of consciousness and death soon after the onset.

[Monostotic fibrous dysplasia in the parietal bone: a case report].

In this paper a case of monostotic fibrous dysplasia in the left parietal bone is described. This 51-year-old female was admitted to our hospital for a head injury on January 12, 1983, and a flat, painless hump (7 X 7cm) was incidentally found in the left parietal region. Plain x-ray film of the skull showed a multicystic lesion with slightly sclerotic margin in the left parietal bone, and outward bulging of the outer table without destruction of the inner table in tangential view. CT scan at the level of bone window clearly demonstrated the same abnormality and intradiploic mass separated by some bony septums. Angiography revealed no positive findings, but RI bone scan (99m Tc) showed an abnormal uptake in this lesion. On February 1, 1983, operation was performed to verify the nature of the lesion and for relief of the left-sided headache. Post operative course was uneventful. Histological findings of this mass were of inactive fibrous dysplasia with fibrous tissue replacing the normal bone and surrounded by island or scorlled edge of bones. Monostotic fibrous dysplasia in the cranial vault is rare. It is often possible to make diagnosis in this disease on the clinical course, plain x-ray film and CT scan showing cystic findings and outer table bulging, and RI scan demonstrating abnormal uptake.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of laparoscopic nephrectomy for ectopic vaginal ureter in a child].

An 11-year-old girl presented with continuous incontinence since infancy. Neither intravenous pyelography nor renal scintigraphy demonstrated the left upper urinary tract, but a very small left kidney was detected close to the 3rd lumbar vertebrae on computed tomography (CT). After cystoscopy, the patient was diagnosed with ectopic vaginal ureter and hypoplastic kidney. Laparoscopic nephrectomy was performed. Before surgery, a ureteral occlusion catheter was inserted through the meatus which opened in the vagina. The catheter was very useful for locating the small kidney during surgery. The procedure was successful and the surgical duration was short (123 min.) with only slight hemorrhage (15 ml). The patient was able to attend school on the seventh postoperative day. We recommend laparoscopic surgery for the treatment of ectopic ureter.

[A case of congenital hydronephrosis suffering from rupture of the renal pelvis due to trauma].

A 19-year-old male patient was admitted with the chief complaint of left abdominal pain. After receiving a mild punch in the abdomen during boxing exercises, he had severe abdominal pain and was brought to an emergency room. Since abdominal CT scanning revealed the retention of massive fluid in the retroperitoneum, hydronephrotic rupture due to the trauma was diagnosed and nephrectomy was performed. The removed kidney was filled as a result of urinary retention, and congenital hydronephrosis accompanied by the ureteropelvic junction obstruction was macroscopically and pathohistologically diagnosed. Postoperative course was favorable and the patient was discharged on the 10th hospital day.

[A case of ureterovesical malacoplakia that manifested hydronephrosis].

A 70-year-old woman visited a nearby physician with a chief complaint of fever and was admitted to a hospital with a diagnosis of acute pyelonephritis. After discharge, pyuria persisted and examination revealed an intravesical solid tumor. The patient was referred to this department for close examination and treatment. The right kidney was hydronephrotic. The intravesical tumor that was resected was solid yellowish-white and ranged from the neck of the uterus to both ureteral orifices. In addition, a grain-sized tumoral lesion, was found in the lower part of the ureter and was also resected. There was sclerotic thickening localized to the right intramural ureter, which had a slightly edematous interior. This was considered to be the cause of the hydronephrosis and a ureteral stent was put in place. Pathological diagnosis was given as malacoplakia. With this case, placement of a ureteral stent was chosen based on the findings of a minimal ureteral lesion, a narrow area of scarring in the intramural ureter as a probable cause of hydronephrosis, and a judgement of mild obstruction. A stent is less invasive for patients, but consideration should be given to urinary infection due to long-term placement recurrence of malacoplakia due to the increased risk of infection, and trouble with periodical exchanging of catheters due to aggravated scarring. Absence of pyuria or signs of recurrence after seven months' placement suggests that use of the stent was the best method.

The effect of enalapril and sairei-to on survival-time for the rat with subtotal nephrectomy.

The effect of an angiotensin-converting enzyme inhibitor, enalapril, and a Japanese medicinal plant named sairei-to, after administration either alone or in combination, on survival-time due to the protection of proteinuria and the preserving of renal function, was studied in the rat with subtotal nephrectomy. Resection of 2/3 of the left kidney and removal of the right kidney was performed in 28 male Wister rats (220-250 g). The rats were divided into four groups: (1) control (without sairei-to or enalapril); (2) with sairei-to (2.5% in rat chow); (3) with enalapril (50 mg/l in drinking water); and (4) the combination of enalapril and sairei-to. The actual survival-times until natural death after renal ablation in these four groups were 92 +/- 3, 128 +/- 8, 199 +/- 19, and 194 +/- 13 days, respectively. Urinary protein excretion and renal function were markedly protected in the enalapril-treated rats. Urinary endothelin excretion was also attenuated in enalapril-treated rats. Statistical analysis revealed the absence of benefits with sairei-to alone or in combination treatment. In conclusion, enalapril provides protection of proteinuria and preserves renal function, which results in a longer survival-time in the rats having subtotal nephrectomy. However, sairei-to does not show such beneficial effects.

Angiotensin-converting enzyme inhibitor-induced anemia and treatment for erythrocytosis in renal transplant recipients.

Erythrocytosis is not rare in renal transplant recipients, and phlebotomy is still the main treatment. Recently, the occurrence of angiotensin-converting enzyme (ACE) inhibitor induced anemia in patients on chronic hemodialysis and in renal transplant recipients has been reported. We herein report 5 transplant recipients whose hematocrit levels decreased while taking ACE inhibitors, including 2 patients treated with ACE inhibitors for erythrocytosis. The individual mean hematocrit values ranged from 35.0% to 54.7% before treatment and from 27.6% to 42.0% after treatment. The hematocrit level in the 2 patients with erythrocytosis decreased from 54.7% to 39.8% and 47.5% to 27.6%, respectively. Anemia improved after discontinuation or dosage reduction of the drugs. The patients were given the same immunosuppressive drugs, and had good renal function. ACE inhibitor-induced conspicuous anemia was not observed in the transplant recipient who received a kidney from a twin sibling and had not been taking any immunosuppressive drugs, nor in the 8 other patients with diabetes mellitus or chronic glomerulonephritis who served as controls. We conclude that ACE inhibitor-induced anemia may frequently arise in an immunosuppressed state. Based on these events, the ACE inhibitor can be used as a potent drug for erythrocytosis in post-transplant recipients.

Allelic loss on chromosomes 3p, 5q and 17p in renal cell carcinomas.

Loss-of-heterozygosity (LOH) has been studied on 3p (von Hippel-Lindau gene locus), 5q and 17p (p53 gene locus) by a polymerase chain reaction (PCR)-based strategy in 42 sporadic renal cell carcinomas (RCC). LOH at seven microsatellite loci on 5q was investigated because a tumor suppressor gene on 5q involved in the development and/or progression of RCC has not yet been identified. LOH was found in seven (17%) RCC at single or multiple loci on 5q, 38% (11/29 informative cases) on 3p, and 6% (2/35 informative cases) on 17p. Replication error (RER) was present in 10% (4/42) RCC at single or multiple loci. The minimum region of deletion on 5q to account for LOH was mapped to 5q31.1 (interferon regulatory factor-1; IRF-1 locus), where LOH was detected in 23% (6/26 informative cases). LOH on 3p and 5q occurred in both stage 2 and more advanced (stage 3 and 4) tumors at similar incidences (41 and 33% on 3p; and 24 and 22% on 5q, respectively), suggesting that LOH on these chromosomes is an early genetic event. All RCC exhibiting LOH on 3p or 5q (IRF-1 locus) were the clear cell or the mixed clear and granular cell types. These findings suggest that LOH on 3p and 5q plays an important role in the genesis of clear cell RCC. In addition, only one tumor exhibited LOH on both 3p and 5q, which suggests that LOH occurs not sequentially but independently.

Telomerase activity in human renal cell carcinoma.

PURPOSE: Telomerase activity has been detected in a wide variety of human tumors. The present study evaluated telomerase activity in association with the acquisition of renal cell carcinoma (RCC). METHODS: Telomerase activity was examined in 30 RCC and the adjacent normal kidney tissue, obtained as surgical specimens. The activity was assayed by polymerase chain reaction-based telomeric repeat amplification protocol assay. RESULTS: Among the 30 RCC, 18 (60%) displayed telomerase activity, whereas none of the normal tissue samples exhibited it. Subdivision of the tumors according to telomerase activity did not reveal any obvious difference in distribution with regard to tumor size, stage, histocytological subtype, or DNA-ploidy. However, a statistically significant relationship was found between the frequency of telomerase-positive activity and both serum immunosuppressive acidic protein level in the patient and tumor grade (P<0.05). There was no significant difference in the recurrent-free survival and the disease-specific survival between patients with positive telomerase activity and patients with negative activity. CONCLUSION: The present results indicate that telomerase activity might be related to the progression of RCC and thus a marker of malignant potential.

Patient response to hydrogel contact lenses: a comparative study.

Eleven subject (22 eyes) wore the best fitting lenses of each of four different types of hydrogel contact lenses (Bausch and Lomb Soflens contact lenses, Hydrocurve HCII contact lenses, AOSOFT-TM/Aquaflex hydrophilic contact lenses, and Alcon Tresoft contact lenses) in a random order for 2-3 week periods so that their short-term responses to the lenses could be evaluated and compared. None of the subjects had any contraindications to hydrogel lens wear. All the lenses centered well with proper movement. Using a double masked procedures, we evaluated each patient's response to each lens type according to the standard of success of Sarver, Harris and Polse. Approximately 63% to 72% of the patients were successful with each lens type. We found no statistically significant differences in the patients' responses to the different lens types, even though individual differences were found. The majority of our subjects were successful with several or all of the lens types evaluated.

Renal small cell carcinoma (neuroendocrine carcinoma) without features of transitional cell carcinoma.

Seventeen cases of renal small cell carcinoma have been reported in the literature. Approximately half of the reported cases show combined features of transitional cell carcinoma. Presented herein is a case of renal small cell carcinoma in a 37-year-old Japanese male who had been treated for 10 years with famotidine for duodenal ulcer. He suffered from sudden-onset chest pain at presentation and myxoma of the right atrium was suspected. He was treated by atriotomy and a tumor was removed from the right atrium and pulmonary artery. Histological examination, however, revealed it to be small cell carcinoma. Accordingly, a radical operation was performed for the removal of a tumor found in the right kidney. Histological examination of the tumor confirmed the presence of renal small cell carcinoma without any features of transitional cell carcinoma. It is reported that long-term administration of an histamine 2 (H2) receptor antagonist may produce carcinoid tumors in rodents and enterochromaffin-like cell hyperplasia in humans. The possible relationship between neuroendocrine carcinoma and H2 receptor antagonist therapy is discussed.