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A 59-year-old patient with diabetes mellitus had been treated with human recombinant insulin for 4 years. He developed a solid mass on his left abdomen at the insulin injection site, which had an overlying pigmented verrucous plaque and keratinized papules, similar to acanthosis nigricans (AN). On histological examination, the mass was found to contain a deposit of amyloid in the dermis, with hyperkeratosis, papillomatosis and acanthosis in the epidermis. Using immunohistochemistry, the amyloid deposits were found to be positive for insulin. A few cases of localized insulin-derived amyloid deposits at injection sites have been reported previously, but none had significant epidermal changes. The coexistence of dermal insulin-derived amyloidosis and an overlying AN-like change, as found in our patient, has not been reported previously, to our knowledge. The presence of a tumour-like lesion at the injection site should be carefully examined, as injection of insulin into amyloid deposits can result in insulin resistance.

Plasma levels of the vascular endothelial cell markers, thrombomodulin (TM), plasminogen activator inhibitor-1 (PAI-1), tissue type plasminogen activator (t-PA), and von Willebrand factor (vWF) were measured in 55 patients on maintenance haemodialysis (HD). TM, PAI-1 and vWF antigen levels were significantly increased in patients before HD, but t-PA antigen was not Compared with levels before HD, t-PA and vWF antigens were significantly increased 1 h after HD and at the end of HD. TM antigen was significantly increased 1 h after HD, and plasma PAI-1 antigen was decreased at the end of HD. TM and vWF antigen levels were negatively correlated with the time (years) on HD. It is concluded that HD may cause endothelial cell damage and that the increases in plasma TM, PAI-1 and vWF levels before HD, and the decrease in the release of TM and vWF antigens from vascular endothelial cells, might be caused by vascular endothelial cell damage from long-term HD.

Hemostatic abnormalities were examined in 55 patients during maintenance hemodialysis (HD). Before HD, plasma protein C and protein S antigens were almost within the normal range, while plasma thrombin-antithrombin III complex (TAT III) and plasmin-plasmin inhibitor complex (PPIC) levels in HD patients were increased slightly, and plasminogen activator inhibitor 1 level was significantly increased, compared to that in normal volunteers. Plasma activated protein C (APC) and protein C inhibitor (PCI) complex and APC alpha 1 antitrypsin (alpha 1AT) complex were not detected in normal volunteers; however, plasma APC-PCI complex was increased in 36 of the patients and plasma APC-alpha 1AT complex was increased in 25 patients. Plasma PCI levels in these patients before HD were significantly decreased. Plasma TAT, PPIC, and tissue type plasminogen activator levels were significantly higher before HD than after 1 hour HD and at the end of HD, while the changes in plasma protein C antigen, protein S antigen, PCI antigen, APC-PCI complex, and APC-alpha 1AT complex were not significant after 1 hour of HD or at the end of HD compared to levels before HD. Plasma PCI levels were correlated with APC-PCI complex, suggesting that decreased PCI levels might be caused by the activation of protein C.

We calculated microvessel counts (MVCs) by analyzing CD31-stained sections in three tumor zones (central, intermediate, and peripheral) in 147 cases of invasive ductal carcinoma (IDC). The purpose of the study was to discover whether there is a difference in MVC in the different zones of tumor, which zone contains the highest MVC within the tumor, from which zone the MVCs best correlate with tumor recurrence or tumor death, and which histologic factors correlate with the MVC of the tumor. Sections were scanned to assess the highest number of microvessels in any single 200 x field (0.384 mm2). In all of our cases, the average MVCs of the central, intermediate, and peripheral zones of the IDCs were 34.4, 39.4, and 51.5 per 200x field, respectively. The MVC significantly increased from the central to the peripheral zones (P.001). In the univariate analysis, in at least one tumor zone, the MVC was correlated with T classification, tumor necrosis, fibrotic focus (a scar-like area within IDCs), and c-erbB-2 protein expression. The only factor significantly correlated with a higher MVC in all of the three zones was fibrotic focus. Moreover, in the multivariate analysis, tumors having high MVCs in the peripheral zone were significantly associated with higher hazard ratios for tumor recurrence (P.05). This study showed that the MVC of an IDC significantly increases from the central to the peripheral zones, and it showed that angiogenesis in the peripheral zone is associated with prognosis. Therefore, estimation of angiogenesis should be performed in the peripheral zone for reliable prediction of outcome in breast cancer patients. As a surrogate for angiogenesis, fibrotic focus seems to be a useful marker for malignant potential in breast cancer.

We investigated the utility of examining biological markers to predict chemoresponse and survival. The subjects consisted of 39 unresectable gastric cancer patients treated with a combination of 5-fluorouracil and cis-platinum. The expression of p53, bcl-2, thymidylate synthase (TS), glutathione S-transferase pi (GST-pi), and vascular endothelial growth factor (VEGF) in the formalin-fixed biopsy samples of primary tumors before chemotherapy was examined immunohistochemically. The positive rate for VEGF, bcl-2, TS, p53, and GST-pi was 51, 10, 46, 38, and 69%, respectively. VEGF-positive cases showed a higher response rate than did negative cases (11 of 20 versus 2 of 19 cases; P = 0.0057). The cases that were negative for p53, TS, bcl-2, and GST-pi were more likely to respond to chemotherapy than the cases that were positive for these markers. The 10 cases having 4 or 5 favorable phenotypes (VEGF positive, p53 negative, bcl-2 negative, TS negative, and GST-pi negative) survived longer than the remaining 29 cases (P = 0.0069). Multivariate analysis revealed that the number of favorable phenotypes (or = 4 versusor = 3) had a greater impact on survival than performance status (0 versus 1 or 2), age (60 years versusor = 60 years), macroscopic type (scirrhous versus nonscirrhous), histological type (intestinal versus diffuse), or tumor extent (locally advanced versus metastatic). Immunohistochemical examination of biological markers in biopsy samples may be useful in predicting the clinical outcome of unresectable gastric cancer patients treated with 5-fluorouracil and cis-platinum.

To determine the appearance of pancreatic adenocarcinoma on delayed contrast enhanced computed tomography (CT) and verify the diagnostic significance.Twenty-two surgically resected lesions of pancreatic adenocarcinoma were studied with dynamic CT and findings were compared with those on histopathology.Ten (45%) of 22 pancreatic adenocarcinoma demonstrated masses on unenhanced CT, while 21 (95%) demonstrated on early contrast-enhanced CT (early CT), and 15 (68%) demonstrated masses on delayed contrast-enhanced CT (late CT). Pancreatic mass was demonstrated as a low-density area on unenhanced and early CT, but mass density varied on late CT. Delayed enhancement of the mass was predominantly observed in small lesions; 3 (75%) of 4 lesions 2 cm or smaller were detected as high-density areas. Histologically, delayed enhanced lesions showed severe or moderate degrees of fibrosis.Late CT is useful for the detection of pancreatic adenocarcinoma with fibrosis as a high-density area, especially in small lesions.

We have reviewed 37 patients with primary orbital lymphoma, using the Ann Arbor criteria and the Working Formulation and its modification. Thirty-one patients had stage I disease, four stage II, one stage III and one stage IV. The male to female ratio was 2.7:1. There were 34 low-grade tumours (including 24 mantle zone) and three intermediate-grade. Patients were divided into three groups according to their primary treatment. Group 1: radiotherapy (17 cases); Group 2: surgery alone (13 cases); Group 3: chemotherapy (seven cases). Patients were followed up from 5 months to 24.3 years, with a mean and median of 7.6 and 6.2 years, respectively. The BMDP software package was used for survival estimation (Kaplan-Meier) and determination of prognostic variable (univariate Cox regression). Local relapse-free survival at 10 years was 100% in Group 1, 0% in Group 2 and 42% in Group 3 with a statistically significant difference (p < 0.01) in favour of radiotherapy. Statistically significant good prognostic features were: complete remission (CR) in response to initial treatment, primary radiotherapy and older age. For stage I cases, there was no difference in distant relapse-free survival in the three groups. The overall cause-specific survival for stage I patients at 10 years was 100% for each group and at 20 years was 100, 67 and 0% for Groups 1, 2 and 3. The difference between the primary radiotherapy and chemotherapy-treated groups was significant at the p = 0.08 level. Statistically significant prognostic factors were early stage, low-grade histology and primary radiotherapy. In one patient, ptosis and diplopia appeared after surgery. One case of glaucoma required enucleation, one patient suffered severe dry eye syndrome. All patients (11/11) in whom the lens received direct radiation developed cataracts of different degrees if follow-up was long enough. Cataract formation was prevented by adequate lens shielding. One patient in CR from a stage I low-grade tumour died from chemotherapy-induced marrow aplasia. Primary orbital lymphoma is an indolent, usually stage I disease, showing low to intermediate-grade histology. After biopsy the best treatment is 30 (low-grade) to 40 Gy (intermediate-grade) carefully planned, lens-sparing megavoltage radiation without adjuvant chemotherapy.

Longstanding inflammation in chronic pyothorax (CP) plays a role in the development of pleural lymphoma; therefore, in 1987, the term pyothorax-associated lymphoma (PAL) was proposed. A recent study showed in the tumor cells of a limited number of patients, the presence of the Epstein-Barr virus (EBV) genome together with the expression of latent infection genes in the tumor cells of PAL. The purpose of the present study is to evaluate an association of EBV with PAL in a large number of patients. In addition, the presence of the EBV genome was examined in cases with CP without PAL. Histologic, immunohistochemical studies, and analyses by polymerase chain reaction (PCR) and in situ hybridization method for EBV were performed on 34 PAL and 16 CP collected by nationwide study. Median age of the patients in both diseases was approximately 70 years with a marked preponderance in men. Mean duration of CP in patients with CP alone and with CP complicated with PAL was 33 and 37 years, respectively. Histologically all PAL were non-Hodgkin's lymphoma, with immunoblastic type being the most common. Immunohistochemistry revealed 28 of 34 PAL to be B-cell type. Combined PCR, in situ hybridization method, and immunohistochemistry showed that the EBV genome was detected in lymphoma cells in 85% of PAL with almost constant expression of latent membrane protein-1. The EBV genome was detected by PCR in only one of 16 CP.(ABSTRACT TRUNCATED AT 250 WORDS)

Three patients with chronic pulmonary embolism underwent successfully unilateral pulmonary arterial thromboembolectomy. In these cases, severe degree of right heart failure and respiratory distress were the primary indications to the operation. Under normothermic partial cardiopulmonary bypass, right unilateral pulmonary thromboembolectomy were performed with beating heart. Distal counter-incision was found to be facilitated to remove thrombi completely from the distal pulmonary artery. In the results of long-term study, postoperative cardiac catheterization data encouraged us to use this technique in the surgical treatment for the selective cases of this disease. All three patients have been doing well without any sign of recurrence up to 17 years of the surgery.

Thirteen cases of sebaceous gland carcinoma and 10 cases of sweat gland carcinoma were studied using immunohistochemical staining for proliferating cell nuclear antigen (PCNA), c-erbB-2, and p53 to examine correlations among them, and to determine the best predictor of patient prognosis. Many sebaceous gland carcinomas and sweat gland carcinomas showed nuclear accumulation of p53, and patients with tumors showing a PCNA index (percentage of nuclei stained for PCNA) higher than 20%, and a p53 index (percentage of nuclei stained for p53) higher than 10% had short survival. Sebaceous gland carcinomas and sweat gland carcinomas showing c-erbB-2 expression had high PCNA (20%) and p53 (10%) indices, and were associated with poor prognosis. Histologically, sebaceous gland carcinomas showing a high degree of differentiation and severe nucleolar atypia had high PCNA and p53 indices. A growth pattern of small solid nests and strands, a low degree of differentiation, and the presence of lymphatic permeation in sweat gland carcinoma were often associated with high PCNA and p53 indices. These results suggest that nuclear accumulation of p53 plays an important role in the development of sebaceous gland carcinoma and sweat gland carcinoma. Assessment of PCNA and p53 indices together was very useful for prognostication of patient outcome, using cut-off values of 20% and 10%, respectively, to separate good prognosis from poor. Differentiation of sebaceous gland carcinoma, and c-erbB-2 expression by sweat gland carcinoma were significant independent prognostic indicators.

Most reports on emergency coronary revascularization deal with failed percutaneous transluminal coronary angioplasty (PTCA) or refractory ischemia which developed after hospital admission. The objective of this study was to evaluate the feasibility and prognosis of emergency revascularization for acute myocardial infarction evolving outside the hospital. Between 1974 and 1992 54 cases were included in this study. The patients had both electrocardiographic and clinical evidence of ongoing ischemia. One or more infarct-related obstructed coronary arteries were documented by emergency angiography. Since 1981, the patients have been given urokinase, and, since 1986, they have undergone PTCA initially and, when reperfusion failed, revascularization was started. Overall in-hospital mortality has been 11.1% (6/54). All other patients were discharged in satisfactory condition. Follow-up for periods of up to nearly twenty years has been uneventful with the exception of two late sudden deaths. The above results confirm that emergency coronary revascularization is a therapeutical option worth considering.

Clinicopathologic aspects of 52 thymomas were reviewed. Masaoka staging revealed stage I in 32, stage II in 2, stage III in 12, stage IV a in 3, and stage IV b in 3. Eleven patients (21%) had associated myasthenia gravis (MG), and three (6%) had pure red cell aplasia (PRCA). Operation was complete resection in 39 patients (stage I 32, stage II 2, stage III 2, and stage IV b 3), subtotal resection in 4 patients (stage III 2, stage IV a 2), partial resection or simple biopsy in 7 patients (stage III 6, stage IV a 1). Survival rates at 5 years and 10 years were 88%, 88% in noninvasive thymomas, and 65%, 45% in invasive thymomas, respectively. Statistical analysis indicated that patients with noninvasive thymomas had significantly longer survival than those with invasive thymomas. Significant difference was not found in survival on the basis of tumor cell type according to lymphocyte/epithelial cell ratio. Associated MG had no influence on the survival of thymoma patients, however, the presence of PRCA was an adverse factor in survival. In cases of invasive thymomas, there was statistically significant difference in the survival rates between the group of patients undergoing complete or subtotal resection and the group undergoing partial resection or only biopsy. Irradiation was of value in local control of thymoma, but lymphogeneous or hematogeneous recurrence occurred in 21% of patients with invasive thymomas from 3 months to 12 years postoperatively. Lifelong follow-up should be necessary in thymoma patients since late recurrence is not so rare.

Four patients, one woman and three men, with biliary cystadenocarcinoma were surgically treated during a 7-year period. The mean age was 58 years. Symptoms prior to admission were mild, and blood tests including liver function tests, CEA and AFP were for the most part within the normal range. Surgery followed diagnostic work-up including US, ERCP, CT, angiography and MRI. Radical surgery was accomplished in three patients by extended left lobectomy in two and extended right lobectomy in one patient, respectively, in this latter patient preceded by therapeutic embolization of the right portal branch prior to resection, while the fourth patient had a palliative resection. Histological examination revealed papillary adenocarcinoma with mucin production within the cyst. The size of the cyst (maximum diameter) varied between 4.5 and 24 (mean 12) cm. The postoperative course was uneventful in all patients. Two patients are alive with no sign of recurrence 5 and 53 months after surgery, while two patients died after 26 and 75 months, respectively. Thus, radical resection of this rare kind of malignant hepatic tumor seems to offer a chance of long-time survival.

This paper was presented to demonstrate the efficacy of postoperative PTCA for varying degree of stenosis aortocoronary bypass with saphenous vein grafts. The following conclusions were drown. 1. The success rate of postoperative PTCA for 15 grafts showed 88.8%. 2. The rate of success for PTCA was much more effective in patients within one year after bypass operations. The authors concluded that postoperative PTCA can be done with excellent rate of success. Therefore, postoperative cine-coronary angiography should be done to evaluate the state of the graft and to decide to perform possible postoperative PTCA in order to keep long time patency rate of saphenous vein grafts.

We report an immunohistochemical study of the distribution and number of interdigitating reticulum cells (IDC) and S-100 beta-positive small lymphocytes (S-100 beta + lymphocytes) in 53 thymomas and 11 thymic carcinomas. All 53 thymomas showed the presence of IDC in the tumor parenchyma. In most cases of predominantly lymphocytic and mixed-type thymoma, IDC clustered in areas, that corresponded to locations that had medullary differentiation and contained accumulated mature lymphocytes. By contrast, in most of the predominantly epithelial-type thymomas, IDC were scattered rather than forming clusters. The distribution and number of IDC were correlation with the histological type of thymoma but not with invasiveness. In thymic carcinomas, IDC were scattered in tumor nests. In 47 of the 53 thymomas (89%), infiltrating S-100 beta + lymphocytes were readily recognized. The remaining six cases without S-100 beta + lymphocytes were noninvasive thymoma. We conclude that the degree of S-100 beta + lymphocyte infiltration is correlated with the stage of thymoma and may be a marker of thymoma malignancy.

An evaluation of excisional biopsy for tongue carcinoma (T1, T2) as a surgical treatment was performed. Forty-seven patients who received excisional biopsy among 394 patients with tongue carcinoma (T1, T2) treated in National Cancer Center Hospital during 24 years were examined. These patients were divided into following three groups: group a) patients treated with excisional biopsy only, group b) those treated with excisional biopsy and cryosurgery, group c) those treated with excisional biopsy and radiotherapy. We examined local control rate of these groups, degree of differentiation in histopathological examination, and median cancer free surgical margin. From these we obtained following results: 1) There was no significance in local control rate among these three groups (group a 77%, group b 84%, group c 45%) 2) There were no local recurrences in the patients with cancer free margin of 5 mm or more except when the histopathology showed perineural invasion, lymphatic vessel invasion, and/or deep invasion to the muscle. 3) Even if we had cancer positive surgical margin with excisional biopsy, we could obtain high local control rate (75%) with additional cryosurgery. We conclude that excisional biopsy for tongue carcinoma (T1, T2) is a good method for primary therapy.

A 57-year-old male was introduced to our hospital for his drug resistant non-ischemic ventricular tachycardia causing faintness attack. Preoperative electrophysiological studies led to a diagnosis of ventricular tachycardia originating from the right ventricular outflow tract. After ventriculotomy, an abnormal muscle band was noticed in the right ventricular outflow tract, which seemed to be a focus of tachycardia by endocardial mapping. Myocardial excision with the abnormal muscle band was performed. In addition to, cryoablation was performed surrounding this area. After the operation, the ventricular tachycardia disappeared completely. No antiarrhythmic drug have been required at 18 months postoperative months.

A 45-year-old female had sudden onset of severe headache, nausea and vomiting without any inducing moments and was transferred to our hospital by an ambulance car. On admission the patient was alert and showed only signs of meningeal irritation. There were no other neurological deficits at all. Immediate CT examination revealed a small high density spot in the area of the right basal ganglia, and a large high density in the frontal horns of both lateral ventricles. Right carotid angiogram showed completely patent carotid siphon with Moyamoya vessels. A small round aneurysmal shadow of 3 mm in diameter was seen in the area of these Moyamoya vessels of the right basal ganglia, and it was thought to be corresponding to the high density spot in the CT examination. Left carotid angiogram showed stenosis of C portion with typical Moyamoya vessels. Therefore, diagnosis of atypical Moyamoya disease with a ruptured aneurysm and ventricular penetration of hematoma was made. The patient was placed on conservative treatment. On 25th day from onset, repeated angiogram showed enlargement of the aneurysmal shadow from 3 mm to 5 mm in diameter. So, on 33rd day, right STA-MCA anastomosis and encephalomyosynangiosis were carried out. Angiogram on 12th day after surgery revealed no aneurysmal shadow. The patient was discharged without any neurological deficit at all. Previous paper, which reported cases of Moyamoya disease with aneurysm, were reviewed. According to the location of the aneurysm, these cases were classified into 3 types angiographically; type I: aneurysm in the area of Moyamoya vessels, type II: aneurysm of cerebral-peripheral artery, and type III: aneurysm of the circle of Willis. It has been generally believed that the Moyamoya disease may be associated with either a true or a pseudoaneurysm in the case of type I. However, pseudoaneurysm in the area of Moyamoya vessels has not been found in postmortem examination but true aneurysms so far. Therefore it may not be denied that the aneurysm of this case was true aneurysm although it showed an enlarging tendency and disappeared rather spontaneously.

Nineteen adult patients with cancer received six to 10 monthly treatments of doxorubicin and cisplatin. Recumbent pulse was measured for 24 to 30 hours before each treatment. Treatment was stopped for disease progression or when a total doxorubicin dose of 550 mg/m2 was reached. Rising serial 24-hour pulse averages predicted congestive heart failure reliably. No patient had congestive heart failure during therapy, but three patients had congestive heart failure two to four months after receiving 540, 525, and 530 mg/m2 of doxorubicin. In these, two to six months before completion of therapy, the 24-hour rhythm-qualified mean (mesor) of pulse showed a positive slope by linear regression analysis (p less than 0.05) that was apparent at cumulative doxorubicin doses of 300, 420, and 240 mg/m2. All 19 patients received similar total doses of doxorubicin and were followed to death or 12 months after the last doxorubicin dose. In addition, a progressive rise in the 24-hour mean pulse coincided with histologically documented doxorubicin-induced lethal congestive heart failure in Wistar-Kyoto rats of both sexes.

SM-108 (4-carbamoylimidazolium-5-olate) is a new purine antagonist which blocks IMP dehydrogenase, the key enzyme of de novo GMP biosynthesis. Eleven patients were entered into a clinical study of SM-108 for the treatment of myeloproliferative disorders. These included 10 cases of chronic myelogenous leukemia (CML) and one case of essential thrombocythemia (ET). Two cases of CML had received prior chemotherapy. SM-108 was given orally at a dose of 400-600mg/m2 daily. Of nine evaluable cases, four cases of CML achieved complete responses and two cases of CML achieved partial responses (response rate = 66.7%). The duration of drug action was short, and the daily dosage required adjustment at frequent intervals. Long-term response without therapy has not been seen with SM-108 in CML. There was no response in the case of ET. The side effects included constipation (1/11), diarrhea (1/11) and mild hepatic toxicity (1/11). No cardiac or renal toxicity was observed.

Seven patients with coexistent Wolff-Parkinson-White (WPW) syndrome and variant angina pectoris underwent surgical interruption of an accessory atrioventricular conduction pathway. In two of these patients, perioperative coronary artery spasm occurred. One patient had a perioperative myocardial infarction and the other patient treated successfully had no infarction. Nitroglycerin and nifedipine were administered during and following operation in the other 5 patients without perioperative coronary artery spasm. No adverse effect was observed in the intraoperative electrophysiological study. Combined therapy of intravenous nitroglycerin administration and sublingual nifedipine administration are useful in the perioperative management of patients with coexistent WPW syndrome and variant angina pectoris.

Three cases with ectopic atrial tachycardia and two cases with atrial flutter (AF), unresponsive to drugs, are described clinically and electrophysiologically. The three patients of ectopic atrial tachycardia were treated by surgical removal of ectopic focus and cryocoagulation of the adjacent area, not using cardiopulmonary bypass. All of them have been in sinus rhythm and had shown no tachycardia since the operation. In one patient of AF, cryosurgical ablation around the atrioventricular (AV) node and His bundle has prevented AF without AV block. Another patient of AF underwent cryoablation around the orifice of the coronary sinus, which was the earliest activation area during AF in endocardial mapping. In this patient, AF reappeared, so cryoablation around the AV node and His bundle was performed. His heart rate decreased to 120 beat/min from 270 beats/min during AF and a radiofrequency pacemaker (Atricon) was implanted to interrupt the remaining AF. This cryosurgical procedure is successful to modify and preserve AV conduction.

Lymph node biopsy specimens from nine patients with a systemic lymphoproliferative disorder morphologically resembling Castleman's disease were studied for the presence of cytoplasmic immunoglobulins. After trypsinization of tissue sections, the avidin-biotin-peroxidase method was used to stain for IgG, IgA, and IgM heavy chains and kappa and lambda light chains. All cases showed polyclonal proliferation of plasma cells. The predominant immunoglobulin class observed was IgG. The IgM-containing cells tended to be localized concentrically around germinal centers. No notable changes were seen in multiple biopsy specimens from five patients. Polyclonal staining was also observed in lymph nodes obtained at autopsy from a patient who died of a disseminated atypical immunoproliferative process. The polyclonal staining pattern in these cases confirms the reactive nature of this systemic lymphoproliferative disorder.

Lymphocyte subsets in pulmonary venous blood (PVB) smears from 42 patients with lung cancer were immunocytochemically determined. In four patients, pulmonary arterial blood (PAB) smears were also studied for comparison with PVB. Seven healthy donor peripheral blood (PB) smears were used as controls. The percentage of T cells, helper/inducer T (Th) cells and B cells were significantly lower (P less than 0.01) than in normal controls but those of suppressor/cytotoxic T (Ts) cells, natural killer (NK) cells (P less than 0.01) and S100+ small lymphoid cells (P less than 0.05) were higher. This resulted in a decrease in the Th:Ts value in cancer patients (1.46 vs. 2.28 for normal controls; P less than 0.01). The Th and Ts value of PVB from patients in pathological Stages III and IV was lower than from those in Stages I and II because of the increase in Ts cells in the former (P less than 0.05). S100+ small lymphoid cells were increased in cancer patients, especially in those with adenocarcinoma. The present study demonstrates immunoregulation abnormalities in cancer bearing hosts, the results correlating well with the stage of the cancer. Determining lymphocyte subset alterations in PVB did not, however, enable us to detect the changes associated with local immune responses against cancer.

The effects of left ventriculotomy on left ventricular performance were studied in seven patients with ventricular tachyarrhythmia (VT) and nine patients with left ventricular aneurysm (LVA). Hemodynamic and left ventriculographic findings were evaluated before and after operations. In VT the non-contracting areas, measured at end-diastole, as mean 10.8 +/- 7.1% of the left ventricular internal surface area. There was no significant fall in left ventricular ejection fractions (EF), cardiac indexes (CI) and left ventricular end-diastolic volume indexes (LVEDVI) after left ventriculotomy. In LVA, the non-contracting areas decreased from 31.0 +/- 7.4% to 13.7 +/- 13.5% (p less than 0.01) in association with a reflex decrease in LVEDVI from 117 +/- 31.8 ml/m2 to 90.4 +/- 24.7 ml/m2 (p less than 0.05). EF increased from 40.8 +/- 7.00% to 54.6 +/- 10.7% (p less than 0.01). There was no significant change in CI and left ventricular stroke volume index after left ventricular aneurysmectomy. The observations indicate that left ventriculotomy of limited size is an acceptable and a safety approach to the ventricular tachyarrhythmias and another cardiac operations.

A 64-year-old man presented with mediastinal and bilateral hilar adenopathy, and a biopsy of a scalene node revealed non-Hodgkin's lymphoma. One week after a cycle of combination chemotherapy, he developed an esophagobronchial fistula. Following a resolution of pneumonia by antibiotics, a cervical esophagostomy was made and, after the improvement of his general condition with parenteral hyperalimentation, he was given one course of combination chemotherapy which was continued until the mediastinal lymph node shadow completely disappeared. A subcutaneous bypass operation was performed on the stomach. After receiving one more cycle of intensification chemotherapy, he was discharged. Three months later, a bronchoscopy showed healing of the fistula. Nine months postoperatively, there is no evidence of the lymphoma or the esophagobronchial fistula recurring. Esophageal involvement is rare in malignant lymphoma and this is only the sixth reported case of esophageal fistula of the respiratory tract in association with lymphoma, and just the second to be treated successfully.

With the advancement of dialysis techniques, rehabilitation and high morbidity are becoming serious problems for patients with chronic renal failure. The authors, with the purpose of investigating the carcinogenic state of such patients, studied the incidence of malignant neoplasms and their immunity both clinically and fundamentally. Out of 499 patients with chronic renal failure, malignant neoplasms were found in 17 cases (3.40%), which is obviously a high rate with a statistically significant difference from that of the ordinary healthy population. In the fundamental immunity study, OKM1+ cells of the patients were significantly lower than those of healthy people, and a decrease in NK and K cells was inferred. Incidentally, the lymphocytes of patients strongly inhibited the mitogen response of healthy subjects. This decline in cellular immunity is considered to be closely related to the carcinogenicity of patients with chronic renal failure.

The modified histologic grading system for solid ovarian teratomas used by Norris et al. which attempts to quantitate the presence and amount of primitive neuroepithelium, is in our opinion, an improvement over the original system. In our experience, however, some difficulties in its application remain. Grade 0 and 1 tumors were easily identified, but there was considerable confusion in attempting to separate grade 2 tumors in which neuroepithelium does not exceed three low-power microscopic fields in any one slide from grade 3 tumors in which neuroepithelium occupies four or more low-power fields. The difficulty arose in deciding whether the amount of neuroepithelium required to qualify as "occupying" a low-power field was sufficient if a single focus was present, or if the entire microscopic field should contain neuroepithelium. In the former case, four small foci of primitive neural tissue present in separate locations in a single slide would qualify for diagnosis as a grade 3 tumor, whereas if the same amount of tissue was found close together (i.e., within the space of a single low-power field), it might be read as a grade 1 tumor. This system is also potentially dependent on a fortuitous sampling technique, since a grade 3 tumor could be diagnosed as a lesser grade if a particular section in which four low-power fields containing neuroepithelium is not chosen for microscopic examination. One of the most important steps in attempting to resolve some of the conflicts surrounding the correlation of tumor histology with natural history in solid ovarian teratomas is to assure adequate sampling of the tumor. Norris et al. suggest that one block per centimeter of the maximum diameter of the tumor should be evaluated, others stress the importance of directing sampling toward areas of hemorrhage or necrosis, in an attempt to disclose immature foci. Because of these potential problems, we suggest as a possible alternative using the estimated percentage of neuroepithelial tissue present in all the tissue examined microscopically as a basis for determining the histologic grade. In our small series, it appears that tumors without neuroepithelium would be equivalent to a grade 0, tumors with up to 10 percent neuroepithelium would be graded 1, those with approximately one-third neuroepithelium would be grade 2 tumors and those with approximately one-half or greater of their tissue as a neuroepithelium would be grade 3 tumors.(ABSTRACT TRUNCATED AT 400 WORDS)

Five cases of the recently characterized cystic mesothelioma of the peritoneum are presented. The patients, all women, ranged in age from 23-50, and were seen with large, solitary or multiple, multicystic masses involving the abdominal and pelvic peritoneum. Histologically, they consisted of interconnecting cystic cavities lined by a single layer of flattened to cuboidal cells with variable nuclear atypia. These cells in one case showed ultrastructural features consistent with mesothelial origin. In follow-up periods ranging from 1-13 years, two patients have had recurrence of disease, but all patients are still alive. When these cases are combined with the ten previously reported, the recurrence rate in patients followed for two years or more is 50% (four of eight). This lesion may represent a clinically "borderline" variant between the better known benign (adenomatoid tumor) and malignant mesotheliomas of the peritoneum.