A high frequency of death-associated protein kinase (DAPK) promoter hypermethylation has been noted in B-cell malignancies, head and neck cancers, and other solid tumors, and it has been used as a tumor marker in molecular detection strategies. Low levels of DAPK promoter hypermethylation, ranging from 0.003 to 1.181%, were detected in peripheral blood cells from 75 of 143 (52%) normal subjects by quantitative methylation-specific PCR (Q-MSP). In 10 of 10 selected patients, MSP amplification of a portion of the DAPK promoter followed by PCR product sequencing confirmed dense hypermethylation of the CpG island in their peripheral blood cells. Q-MSP analysis of fluorescence-activated cell-sorted peripheral blood cells from three of these patients demonstrated that a significantly greater proportion of B cells (1.074-6.026%) were DAPK hypermethylated than were T cells, monocytes, or neutrophils, which were <0.06% hypermethylated. Further analysis after sorting of one subject's B cells into IgM+, IgM-, IgG+, and IgG- subpopulations demonstrated that DAPK hypermethylation was predominantly present in the IgM- compared with IgM+ B cells (3.338% versus 0.436%). DAPK promoter hypermethylation was found in IgM- B cells in normal individuals. The same hypermethylation identified in B-cell malignancies may reflect a clonal outgrowth of B cells arising from this compartment and may indicate a susceptibility to neoplastic transformation in a subset of B cells. Normal circulating lymphocytes with DAPK promoter hypermethylation may act as confounding factors in tumor detection based on DAPK hypermethylation.

Sucralfate is a recently introduced drug that has received acceptance as a nonsystemic, locally active antiulcer agent used in the treatment of duodenal ulcer disease. In addition, sucralfate has been used for the treatment of gastric ulcer and a variety of other gastrointestinal diseases. However, the use of sucralfate to treat caustic esophagitis has not been clinically investigated, and a review of the literature yielded scant information (1). Herein, we report our experience with sucralfate in the treatment of a case of lye-induced esophagitis.

Careful examination of the umbilical area may at times yield unexpected clues to the diagnosis and the pathologic origin of intra-abdominal disease. Metastases from the pancreas may implant on the umbilicus. The mode of distribution of umbilical and paraumbilical implants in our patient with pancreatic carcinoma was most eye-compelling, and forms the substance of this report. Report of a Case.— A 62-year-old man was admitted to the hospital for shortness of breath and for swelling of the abdomen and legs. Results of physical examination were consistent with congestive heart failure. In addition, a firm, irregular, 3 × 4-cm node adherent to the overlying skin was palpable in the right axilla. The abdomen was distended; shifting dullness and fluid wave were present. On digital examination, a rectal shelf was felt. The umbilicus was protuberant and was preempted by a nodular, tender, bluishpink mass that was irregular in contour and outline. Distributed

Hepatomegaly and abnormal liver function can occur in nonmetastatic malignancies. A patient with metastatic prostatic adenocarcinoma that had spared the liver and extrahepatic biliary tree is described. He had puzzling episodes of jaundice for a period of 2 1/2 years. The results of appropriate investigations and an exploratory laparotomy performed dlring the patient's four antemortem hospitalizations were indicative of "recurrent intrahepatic cholestasis," the cause of which remained an enigma even after exploratory laparotomy. At autopsy, no evidence of hepatic metastases or extrahepatic biliary obstruction was found. Alcohol, hepatotoxic drugs, toxins, viral and chronic active hepatitis, hemolysis, and extrahepatic biliary obstruction were eliminated as causes of the jaundice. We believe that the intermittent intrahepatic cholestasis is one of the nonmetastatic manifestations (nonmetastatic hepatopathy of malignancy) of the prostatic adenocarcinoma.