Extradigital glomus tumor causing para-Achilles tendon pain. A case report.

A 48-year-old woman with a 15-year history of a painful nodule in the para-Achilles tendon area was evaluated by clinical examination, magnetic resonance imaging and ultrasonography, then treated by simple surgical excision of the nodule. Pathology revealed a glomus tumor, which is extremely rare in the para-Achilles tendon area. This is the first report of a glomus tumor in this location.

Atrial fibrillation and continuous hypotension induced by sildenafil in an intermittent WPW syndrome patient.

A 55-year-old Japanese man was hospitalized for palpitations and severe chest oppression one hour after he ingested about 1500 ml of beer and sildenafil (Viagra) 50 mg. At 43 years of age, he had been diagnosed with intermittent WPW syndrome following a paroxysmal supraventricular tachycardia (PSVT) attack. He took a 1 mg tablet of doxazosin daily for mild hypertension. On admission, his blood pressure was 90/54 mmHg and his heart beat was weak and irregular with a rate of about 220/min. Since atrial fibrillation (Af) was diagnosed on an electrocardiogram (minimum RR interval; 0.22 seconds), direct current shock was performed with 100 joules and 150 joules but conversion to sinus rhythm failed. Sinus rhythm returned spontaneously from Af four hours after taking sildenafil. Since blood pressure was 50/17 mmHg despite the return to sinus rhythm, blood pressure was maintained by dopamine for twelve hours after sinus rhythm returned. The patient underwent catheter ablation for curative therapy and thereafter has not had any further episodes of tachycardia.

[A case of nodular fasciitis of the chest wall].

We present a case of nodular fasciitis of chest wall origin. A 62-year-old woman visited our hospital because of a rapidly growing hard tumor fixed to her right chest wall, measuring 7 x 8 cm in size. Although incisional biopsy specimen revealed that the tumor was suggestive of nodular fasciitis, the possibility that the tumor had a malignant component could not be excluded. Total excision of the mass with combined resection of 3rd, 4th, 5th ribs was performed to establish the histological diagnosis and treatment plan. We believe that the tumor proved to be malignant by excisional biopsy, should then undergo further excision with sufficient surgical margin. Nodular fasciitis may be misdiagnosed as a sarcoma due to its rich cellularity, mitotic activity and poorly circumscribed nature. Awareness of the histological features of nodular fasciitis, and its predilection for presenting as a rapidly growing mass, should decrease the likelihood of misdiagnosis and the attendant risk of over surgery.

Very low density lipoprotein receptor binds apolipoprotein E2/2 as well as apolipoprotein E3/3.

The VLDL receptor, a newly identified lipoprotein receptor, recognizes apoE containing lipoproteins. The human VLDL receptor was overexpressed in 1d1A-7, a mutant Chinese hamster ovary cells lacking LDL receptors. Each VLDL obtained from a normolipidemic subject with two epsilon3 or epsilon2 alleles similarly competed for the binding of radiolabeled rabbit beta-VLDL to the VLDL receptors. The anti-apoE monoclonal antibody 1D7, which inhibited binding of apoE3 to the LDL receptors, failed to compete for the binding of VLDL (apoE3 or apoE2) to the VLDL receptors. Results indicate that the binding site of apoE on the VLDL receptor may differ from its binding site on the LDL receptor.

[Combination therapy with 5-FU, etoposide and CDDP (FEP regimen) in advanced primary and recurrent gastric cancer].

Surgery is still the treatment of choice in gastric cancer. However, despite the availability of extended surgical procedures, the majority of patients with stage IV gastric cancer have a poor prognosis. Therefore, other treatment modalities, especially systemic chemotherapy, have been investigated intensively. The recent successes achieved with combination chemotherapy regimens, such as EAP, strongly indicated that gastric cancer is chemosensitive. We also treated previously untreated patients with advanced and recurrent gastric cancer. Chemotherapy of CDDP 30 mg/m2 was given intravenously (i.v.) on day 1; etoposide 70 mg/m2 (i.v.) on days 2 to 4; and 5-FU 500 mg/m2 (i.v.) on days 2 to 5. The courses were repeated every 3 weeks. FEP induced an overall response rate of 25%, including 25% PR (primary tumor) and 25% PR (liver-metastasis). The median survival rate for all patients was 7.3 months and partial responses were seen in three patients with a median response duration of 13.1 months. In 2 patients with PR of primary tumor, one patient underwent a second-look operation and one patient refused an operation. Therefore, ten of 12 patients entered have died, and 2 patients remain alive. We concluded that FEP regimen can be useful in the treatment of advanced and recurrent gastric cancer. Moreover, the preoperative use of effective regimens seems to improve prognosis.

Association of HLA-DQw4 with IgA nephropathy in the Japanese population.

We have studied HLA-A, B, DR and DQ phenotypes in 50 Japanese patients with IgA nephropathy. The antigen frequency of HLA-DQw4, which is known to be associated with DR4/Dw15 specificity, was increased in the patient group as well as in those of B35 and DR4. The increase of DQw4 (36.0%) was significantly different from that of national controls (corrected p less than 0.004).

The role of HLA-DR4 in the long-term prognosis of IgA nephropathy.

The study was performed to clarify the relationship between the long-term prognosis of IgA nephropathy and the HLA-DR4 antigen. From the 130 patients typed for HLA antigens, stable (n = 42) and progressive (n = 45) patient groups were selected. DR4 frequency was not different in the two groups (stable, 66.7 vs. progressive, 53.3%). However, the frequencies of HLA-DR4 and B35 in the 130 patients were significantly higher than those in the national control (DR4; 60.0 vs. 41.6%; B35:30.0 vs. 15.5%). We concluded that DR4 played no role in the long-term prognosis of IgA nephropathy, but that B35 and DR4 were associated with the disease in the Japanese population.

[Efficacy of UFT in advanced gastric carcinoma under comparative study of MMC + UFT and MMC + tegafur therapies].

Antitumor effect of MMC + UFT(A) and MMC + tegafur(B) therapies for advanced gastric carcinoma was compared from February 1985 to March 1988. UFT and tegafur were orally given at dose of 400 mg/m2 daily, and MMC was intravenously administered at dose of 6-8 mg/m2 every two weeks. The following results were obtained. 1. Twenty-nine cases entered in this study were divided into A or B therapies at random. All cases entered were eligible. Fourteen of 29 cases were randomized into A therapy and 15 cases into B therapy. One case treated with B was evaluated as incomplete. 2. There were no differences in the characteristics of patients between A and B therapies. 3. Among 29 eligible cases, a partial response was obtained in 3 out of 14 cases (21.4%) treated with A and in 3 out of 15 cases (20.0%) treated with B. Among 28 cases evaluated completely, a partial response was obtained in 3 out of 14 cases (21.4%) treated with each A and B. 4. Response rate with every ps or for every lesion did not differ between A and B therapies. 5. Median survival day treated with A and B therapies was 223 and 181 days, respectively. The survival curve did not differ significantly between the two therapies. 6. The frequency of adverse reactions within eight weeks after beginning the therapy was 64.2 and 73.3% with A and B therapies, respectively. From the results mentioned, it was concluded that the antitumor effect of UFT was not superior to that of tegafur for advanced gastric carcinoma.

[A clinicopathological study of five cases of adenosquamous carcinoma of the stomach].

Five cases of adenosquamous carcinoma with resected stomach were subjected to this study, and the clinicopathological characteristics of this condition were described. The five patients represented 0.8% of 589 cases of resected stomach. There were two men and three women ranging in age from 40 to 70 (average, 62.8). Macroscopically, the adenosquamous carcinomas were all advanced gastric cancer situated in the lower body along the lesser curvature of the stomach, averaging 7.6 cm in size. The characteristic finding was the histologically differentiated type, invading to the serosa. Lymph node metastasis was most prominent.

Carotenoids of tunicates. III. The structural elucidation of two new marine carotenoids, amarouciaxanthin A and B.

The structure of two new marine carotenoids, isolated from the tunicate, Amaroucium pliciferum, and designated as amarouciaxanthin A and B, were determined on the basis of chemical and spectral data. Amarouciaxanthin A was determined as (6S, 3'S, 5'R,6'R)- 6,3',5'-trihydroxy-4,5,6',7'-tetradehydro-7,8,5',6'-tetrahydro-beta, beta-carotene-3,8-dione, and Amarouciaxanthin B was determined as (6S,3'R)-6,3'-dihydroxy-4,5,7',8'-tetradehydro-7,8-dihydro-beta,beta- carotene-3,8-dione. These two compounds are also presumed to be new metabolic products of a typical marine carotenoid, fucoxanthin.