Portal venous tumor thrombus associated with hepatic metastasis of renal cell carcinoma: case report.

We report a case of liver metastasis of renal cell carcinoma with portal venous tumor thrombus. Abdominal computed tomographic images showed a large hepatic mass that enhanced slightly during arterial phase. Multiple hypoattenuating lesions were seen in the intrahepatic portal venous branches and were traced directly from the mass. The histologic specimen confirmed metastatic liver tumor of renal cell carcinoma with portal venous tumor thrombus.

A case of intraductal papilloma of breast in advanced age.

Breast tumors have their various biological characteristics as to advanced age of patients. Intraductal papilloma is a benign tumor of the breast which is known to occur in the premenopausal young females. Tumors of the breast in the senile females are found mainly to be breast cancers. No any cases of intraductal papilloma over 80-years were reported in Japan to date. We have recognized mammary tumors in old aged patients to be cancers, but it is necessary to put it into mind there are a few intraductal papillomas even if advanced in age. In this report, we present the most senile case with intraductal papilloma in our institute.

Exploration of Vogt-Koyanagi-Harada syndrome by infrared choroidal angiography with indocyanine green.

The choroid affected by the Vogt-Koyanagi-Harada syndrome (VKH) has seldom been explored by indocyanine green choroidal angiography. Five patients with definite diagnosis of VKH underwent this investigation. The first case had the most marked leakage, very similar to that on fluorescein angiography. The right eye of case 2 showed fewer leakage points on ICG than on fluorescein angiography, compared with case 1. The left eye of case 2 did not show any leakage. Cases 3, 4 and 5 yielded segmental hyperfluorescence, distant from the posterior pole, which could not be identified by fluorescein angiography. This might indicate segmental choroiditis. There were two types of hypofluorescent lesions; all the cases except case 2 showed early hypofluorescence. Hypofluorescent areas corresponding to overlying retinal detachment were seen in the right eye of case 4. Multiple spots, late hypofluorescence, about 200 to 500 um in size appeared throughout the posterior pole in four eyes out of ten. In conclusion, indocyanine green choroidal angiography provides a wider variety of pictures than fluorescein angiography.

A case of true exfoliation.

Using light and transmission electron microscopy, we have performed a histopathological evaluation of the anterior lens capsule, isolated during cataract extraction from an eye revealing a cellophane-like membrane on the lens surface of the pupil area. In addition to light microscopy showing one third of the anterior capsule had partially detached, transmission electron microscopy demonstrated irregular alignment of capsular structure near the detached regions. These microscopic features, together with clinical findings, led us to believe that this is a case of true exfoliation.

Parathyroid Hormone-related Protein in Breast Cancer Tissues: Relationship between Primary and Metastatic Sites.

The expression of parathyroid hormone-related protein (PTHrP) at primary and metastatic sites was studied retrospectively in specimens obtained at opreation and autopsy from 11 patients. The anti-human PTHrP monoclonal antibody, 4B3, was used in the immunohistochemical studies. The 11 cases showed metastases to the liver and the lung, and 9 showed bone metastases at autopsy. At primary sites, PTHrP was positive in the 9 cases with bone metastases, while the other 2 cases were negative for PTHrP. Regardless of the intensities of immunohistochemical staining of PTHrP at primary sites, cancer cells at metastatic sites in the liver and the lung were almost all negative for PTHrP. On the other hand, all PTHrP-positive cases at primary sites at operation showed skeletal metastases at autopsy, and the intensity of the immunohistochemical staining of PTHrP was strongly positive at all the sites of skeletal metastasis. These results suggest that while PTHrP is an important factor that causes cancer cells to erode and grow in skeletal bone, the expression of PHTrP is, concurrently, affected by an osseous microenvironment.

Femoral and spinal bone mineral density in Japanese osteoporotics with hip fracture.

In the present study, bone mineral density (BMD) of femoral neck and lumbar spine was compared between 38 Japanese female patients with hip fracture (age 63-89 years, mean +/- SD 76 +/- 7 years) and 162 age-matched female controls (age 62-90 years, mean +/- SD 75 +/- 7 years). BMD was measured in the femoral neck and lumbar spine (L2-4) using dual-photon absorptiometry (Norland model 2600). BMD values of femoral neck as well as lumbar spine were significantly lower in patients with hip fracture than in controls (0.504 +/- 0.097 v 0.597 +/- 0.101, p < 0.01, for femoral neck; 0.661 +/- 0.146 v 0.720 +/- 0.128, p < 0.05, for lumbar spine). Patients with hip fracture and controls were stratified according to their BMD levels at two measuring sites, and the ratio of the number of patients and controls at each BMD level was calculated as an indicator of fracture rate. This ratio showed an exponential increase as the femoral neck BMD declined, but only a gradual increase as the lumbar spine BMD declined. Specificity-sensitivity analysis revealed that BMD values of 0.59 and 0.54 g/cm2 at the femoral neck provided a specificity of 52% and 68% with a sensitivity of 90% and 75%, respectively. These findings suggest that Japanese patients with hip fracture are more osteoporotic than age-matched controls and that the selective measurement of femoral neck would be useful for predicting the risk of hip fracture.

The expression of parathyroid hormone-related protein in human breast cancer with skeletal metastases.

The relationship between the expression of parathyroid hormone-related protein (PTHrP) by breast cancer and skeletal metastases, was investigated using a monoclonal antibody against human PTHrP (4B3). The immunohistochemical localization of PTHrP was studied in sections of formalin-fixed, paraffin-embedded tissues from 28 breast cancers obtained surgically between 1980 and 1985. Of the 28 patients, 12 developed skeletal metastases, 8 developed lung metastases, and the other 8 were alive and disease-free at the time of this study. Sixteen of the 28 (57%) tumors showed positive immunoreactivity to 4B3, the PTHrP positive ratio being 83% in the patients who developed skeletal metastases, 38% in those who developed lung metastases, and 38% in those without recurrence, respectively. Thus, a significantly higher proportion of the patients who developed skeletal metastases were positive for PTHrP than the other two groups (P < 0.05). Furthermore, the level of positive staining was strongly related to positivity for estrogen and progesterone receptors (P < 0.01). These results are consistent with the hypothesis that PTHrP might be necessary for metastases to erode bone and grow in skeletal sites, and its expression could be related to certain hormones.

[Immunohistological evaluation of parathyroid hormone-related protein in breast cancer with and without calcification on mammography].

PTHrP is the main factor of humoral hypercalcemia of malignancy. PTHrP produces the same effect on renal and osteoblast membrane in vitro and on calcium and inorganic phosphate fluxes in vivo as human PTH. Physiologically, PTHrP is produced by rat mammary tissue during lactation. It is suggested that PTHrP correlates to the metabolism of calcium in the mammary gland. Using anti-PHTrP (1-34) monoclonal antibody 4B3, we investigated the correlation of PTHrP and calcification in breast cancer. All the breast cancers with calcification on mammography showed positive immunostaining. Most cases without calcification, on the other hand, showed negative. Positive PTHrP staining was not related to the any clinical parameter. It is suspected that PTHrP is also one of the main factors of calcification in breast cancer.

Mesenteric fibromatosis presenting as fever of unknown origin.

We report a case of fibromatosis, soft tissue tumors that are benign histologically, but exhibit behavior intermediate between benign and malignant diseases. Mesenteric fibromatosis grows vigorously without a general inflammatory reaction, and its symptoms are the result of obstruction and/or compression of the intestine. However, in our case, the general inflammatory reactions of fever and C-reactive protein (CRP) elevation was present at an early stage. Because this inflammatory reaction disappeared after surgical resection, it may have been induced by some inflammatory factors produced in the tumor, such as those produced in inflammatory fibrous histiocytoma. We found that computed tomography was useful in the detection of the cause of fever of unknown origin, and suggest that it should be recommended in cases of long-lasting unexplainable fever.

A comparison of the bone mineral density of the vertebral bodies and the hip in elderly females with hip fractures. Assessment using dual photon absorptiometry.

The influence of decreasing bone mineral density with age and the occurrence of hip fractures in elderly females was investigated. Normal hips were studied in 287 healthy women whose ages ranged from 20 to 90 years old. The normal hip in 61 patients who had all suffered a femoral neck or intertrochanteric hip fracture, and were over 60 years old, were also studied and compared. The bone mineral density (BMD) of the lumbar vertebrae and the hip was measured with dual beam photon absorptiometry, for all patients. There was no correlation between the bone mineral density of the lumbar vertebral bodies, and the bone mineral density of the proximal femur. The peak bone mass in e lumbar vertebrae was seen in the thirties, but the peak bone mass in the hip was seen in the twenties. Bone mineral density in the lumbar vertebrae and in the hip was decreased in the patients who had sustained a hip fracture when compared to the control patients. The bone mineral density in the proximal femur was significantly reduced in patients who had sustained a hip fracture, especially in the region of Ward's triangle. These findings suggested that decreased bone mass in the hip at Ward's triangle may be correlated with the occurrence of hip fractures.

Effects of nucleosides and a nucleotide on DNA and RNA syntheses by the salvage and de novo pathway in primary monolayer cultures of hepatocytes and hepatoma cells.

Studies were made on the effects of inosine, guanosine 5'-monophosphate (GMP), cytidine, uridine, thymidine, and their mixture (4:4:4:3:1, OG-VI) on DNA and RNA syntheses in primary monolayer cultures of normal hepatocytes and cultures of hepatoma cells, AH130, to use these compounds for total parenteral nutrition. Addition of an appropriate amount of inosine, GMP, uridine, or thymidine to primary cultures of hepatocytes enhanced both DNA and RNA syntheses by the salvage and de novo pathways. Cytidine appeared to have lower optimal concentration for enhancing these pathways. The OG-VI mixture also enhanced the syntheses of DNA and RNA, but the composition of the mixture was not optimal. Additions of inosine, GMP, uridine, and thymidine to cultured hepatoma cells also enhanced their DNA and RNA syntheses, but the cells consumed more of the added nucleic acid compounds than hepatocytes did. Addition of cytidine had no effect on proliferation of the cells. The OG-VI mixture at relatively higher concentration inhibited the syntheses of DNA and RNA by hepatoma cells. Addition of high concentrations of nucleic acid compounds was found to suppress the proliferation of both hepatocytes and hepatoma cells. These results suggest that addition of optimal amounts of nucleic acid compounds such as nucleosides and nucleotides would enhance growth of hepatocytes, particularly during liver regeneration, but that they may also enhance proliferation of tumor cells in the liver.

One-electron reduction of the oxyform of 2,4-diacetyldeuterocytochrome P-450cam.

The reaction of the hydrated electron with a ferrous oxygenated form of modified cytochrome P-450cam, containing 2,4-diacetyldeuteroheme, was investigated by the use of pulse radiolysis. The ferrous oxygenated form of this enzyme was reduced by hydrated electrons to form the product, which exhibits absorption maximum at 470 and 370 nm. From the spectrum obtained, the oxidation state of the product is discussed in relation to the higher oxidation states of chloroperoxidase.