Successful management of massive pulmonary tumor embolism from renal cell carcinoma

Renal cell carcinoma occasionally invades the inferior vena cava and rarely extends to the right atrium. However, despite the frequency of venous extension, it is unusual to recognize patients with massive pulmonary tumor embolus clinically. We describe a 60-year-old man who underwent pulmonary tumor embolectomy using cardiopulmonary bypass combined with profound hypothermia and intermittent low-flow perfusion. The patient is currently alive and well without implantation metastasis 6 months after the operation.

Periosteal ganglion: a report of three new cases including MRI findings and a review of the literature

OBJECTIVE

To clarify the clinicopathological features of periosteal ganglion.

DESIGN

Three patients with periosteal ganglion were studied clinicopathologically.

PATIENTS

One patient was selected from the files of our institute and two from a consultation file.

RESULTS AND CONCLUSION

All three lesions were located over the medial aspect of the tibia. Plain radiographs showed cortical erosions of varying degrees and mild periosteal reaction of the medial side of the tibia. MR images demonstrated well-circumscribed lesions overlying the cortical bone of the tibia, shown as low-intensity areas on T1-weighted images. On T2-weighted images, lesions were homogeneous, lobulated, and showed a characteristic markedly increased signal intensity. These findings are helpful in making a diagnosis of periosteal ganglion. Each patient had an uneventful clinical course after an excision involving the wall of the ganglion, the adjoining periosteum, and the underlying sclerotic cortical bone.

Antinucleolar autoantibody induced by mercuric chloride in mice: does sodium selenite inhibit autoantibody production?

Repeated exposure of subtoxic doses of mercuric chloride (HgCl2) can induce antinucleolar autoantibodies in susceptible mice. To study the immunopathological mechanism(s), sodium selenite (Na2SeO3), which is known to reduce the toxicity of mercury, is injected simultaneously with HgCl2 into mice. Equimolar Na2SeO3 nor the same amount of Se in Na2SeO3 as Hg in HgCl2 could not reduce antinucleolar autoantibody induction by HgCl2. These results indicate that the mechanism of autoimmunity induction by HgCl2 might be independent of its toxicity.

Comparison of official methods for 'readily oxidizable substances' in propionic acid as a food additive

The official methods for 'readily oxidizable substances (ROS)' in propionic acid as a food additive were compared. The methods examined were those adopted in the Compendium of Food Additive Specifications (CFAS) by the Joint FAO-WHO Expert Committee on Food Additives, FAO, The Japanese Standards for Food Additives (JSFA) by the Ministry of Health and Welfare, Japan, and the Food Chemicals Codex (FCC) by the National Research Council, USA. The methods given in CFAS and JSFA are the same (potassium permanganate consumption). However, by this method, manganese (VII) in potassium permanganate was readily reduced to colourless manganese(II) with some substances contained in the propionic acid before reacting with aldehydes, which are generally considered as 'readily oxidizable substances', to form brown manganese (IV) oxide. The FCC method (bromine consumption) for 'ROS' could be recommended because it was able to obtain quantitative results of 'ROS', including aldehydes.

Entrapment neuropathy of the deep peroneal nerve associated with the extensor hallucis brevis

The authors report a case of entrapment neuropathy of the deep peroneal nerve associated with the extensor hallucis brevis. This entrapment neuropathy was found distal to the inferior retinaculum that causes the anterior tarsal tunnel syndrome. Surgical decompression of the deep peroneal nerve that was entrapped by the extensor hallucis brevis relieved the symptoms. This condition, like the anterior tarsal tunnel syndrome, deserves attention.

Work of flexion after flexor tendon repair according to the placement of sutures

Tendon repairs comparing dorsal or volar placement of sutures were done on 36 flexor profundus tendons from 9 canine cadaveric paws. Three suture techniques were used. Work of flexion as a measure of resistance to tendon gliding was measured in the following groups: Groups 1 and 2: 4-strand Savage technique with 5-0 core suture, dorsal or volar placement; Groups 3 and 4: 4-strand Savage technique with 4-0 core suture, dorsal or volar placement; and Groups 5 and 6: tendon splint technique, dorsal or volar placement. The increase in work of flexion values were 11.3%, 14.1%, 12.2%, 37%, 20.5%, and 92.7% for Groups 1 through 6, respectively. The increase in work of flexion value in Group 4 was significantly greater than that in Group 3, and the value in Group 6 was significantly greater than Group 5. These data suggest that the work of flexion after tendon repair was influenced by the location of the suture material; volar location of suture material significantly increased the work of flexion value.

High-grade surface osteosarcoma of the humerus

We presented a case of high-grade surface osteosarcoma of the humerus in a 12-year-old girl and the results of our analysis of 26 cases reported in the literature. Twelve of the 21 patients for whom substantial follow-up information was reported had died of the disease, and the results of the analysis regarding the efficacy of chemotherapy and medullary involvement were ambiguous. It is emphasized that high-grade surface osteosarcoma is a distinct entity, since it is associated with a poorer prognosis than other osteosarcomas arising on the surface of bone.

RP67580, a neurokinin1 receptor antagonist, decreased restraint stress-induced defecation in rat

We investigated the possibility that substance P would mediate defecation in rats subjected to restraint-stress. The increases in fecal pellet output caused by restraint-stress were inhibited by a neurokinin (NK)1 receptor antagonist, RP67580 with an ED50 (95% confidence limits) value of 0.59 (0.54-0.65) mg/kg i.p. RP68651, the enantiomer of RP67580 devoid of affinity for NK1 receptors, had little effect on it. In contrast, (+/-)SR48968, an NK2 receptor antagonist, was without effect. Furthermore, capsaicin treatment (125 mg/kg i.p.) was inactive in this model. These results suggest that the activation of NK1 receptors and substance P released from intrinsic neurons of the colon would be involved in stress-induced defecation in rats.

[Efficacy of repeated hepatic dearterialization combined with intra-arterial infusion chemotherapy for unresectable tumors of the liver]

In the present study, repeated hepatic dearterialization combined with intra-arterial infusion chemotherapy was performed in patients with unresectable tumors of the liver. Of 36 patients, 16 had primary liver tumors (13 hepatocellular carcinomas and 3 cholangiocellular carcinomas), while 20 had metastatic tumors (7 gastric carcinomas, 10 colon carcinomas, 2 pancreatic carcinomas, and 1 gastric carcinoid). A significantly better survival outcome was found in those with intra-arterial infusion chemotherapy and those without cirrhosis. In the HCC cases, those with the therapy tended to show a better survival as compared with the natural history. Remarkable tumor regression was found in four (67%) of six patients with metastases of gastric cancer.

Nonphotosensitive video game-induced partial seizures

We report a 9-year-old boy with a ring 20 chromosome anomaly whose complex partial seizures (CPS), presumably of frontal lobe origin, were often induced by playing video games. Neither photosensitivity nor pattern sensitivity was observed. An intensive video-EEG investigation showed that video games as well as mental calculation elicited rhythmic runs of bilateral high-voltage slow waves, which eventually evolved into ictal discharges. This case suggests that higher brain functions can be involved in seizure induction.

Primary jejunal adenocarcinoma masquerading as a primary ovarian malignancy

Primary adenocarcinoma of the jejunum which accounts for only approximately 3% of all gastrointestinal tract malignancies, is distinctly unusual. Ovarian metastasis from a jejunal cancer is extremely rare. It has significant therapeutic and prognostic implications to differentiate primary ovarian carcinoma from metastatic disease to the ovary. A 49-year-old Japanese woman presented with intermittent nausea, vomiting, and palpable abdominal mass. Pelvic examination and imaging studies revealed a huge ovarian tumor, suspicious for malignancy. Upper GI series and barium enema were unremarkable. Exploratory laparotomy was done for presumed primary ovarian malignancy. Mucinous adenocarcinoma of the right ovary, measuring 25 x 18 x 12 cm, without other intraabdominal dissemination was found. Exploration of the upper abdomen revealed an annular constriction of the jejunum 30 cm distal to the ligament of Treitz. Partial jejunectomy with end-to-end anastomosis was done. Metastatic ovarian cancer from the primary jejunal adenocarcinoma was confirmed microscopically. Although small bowel malignancy is uncommon, small bowel follow-through examination or enteroclysis may be indicated in patients with positive stool for occult blood who have no abnormality in the upper gastrointestinal series and barium enema. In addition to the imaging studies, thorough exploration of the entire abdominal cavity is necessary at ceiliotomy in patients with ovarian malignancy to distinguish primary ovarian cancer from metastatic disease to the ovary.

Polarization dependence of femtosecond soliton-soliton interactions in dispersion-shifted fiber

The polarization dependence of femtosecond soliton-soliton interaction in a dispersion-shifted fiber has been investigated in detail theoretically and experimentally. For 400-fs soliton pulses the input pulse separation at which the soliton-soliton interaction occurs is 1.6 ps for orthogonally polarized solitons as opposed to 2.3 ps when the polarizations are parallel. Similar to that in the parallel condition, the soliton self-frequency shift in the orthogonal case is accelerated through soliton-soliton interaction. However, the magnitude of the soliton self-frequency shift is reduced to one third of that in the parallel condition.

The chaperonin containing t-complex polypeptide 1 (TCP-1). Multisubunit machinery assisting in protein folding and assembly in the eukaryotic cytosol

Many proteins in the cell require assistance from molecular chaperones at stages in their life cycles in order to attain correctly folded states and functional conformations during protein synthesis or during recovery from denatured states. A recently discovered molecular chaperone, which is abundant in the eukaryotic cytosol and is called the chaperonin containing TCP-1 (CCT), has been shown to assist the folding of some proteins in cytosol. This chaperone is a member of the chaperonin family which includes GroEL, 60-kDa heat shock protein (Hsp60), Rubisco subunit binding protein (RBP) and thermophilic factor 55 (TF55), but is distinct from the other members in several respects. Presently the most intriguing feature is the hetero-oligomeric nature of the CCT; at least eight subunit species which are encoded by independent and highly diverged genes are known. These genes are calculated to have diverged around the starting point of the eukaryotic lineage and they are maintained in all eukaryotes investigated, suggesting a specific function for each subunit species. The amino acid sequences of these subunits share approximately 30% identity and have some highly conserved motifs probably responsible for ATPase function, suggesting this function is common to all subunits. Thus, each subunit is thought to have both specific and common functions. These observations, in conjunction with biochemical and genetic analysis, suggest that CCT functions as a very complex machinery for protein folding in the eukaryotic cell and that its chaperone activity may be essential for the folding and assembly of various newly synthesized polypeptides. This complex behaviour of CCT may have evolved to cope with the folding and assembly of certain highly evolved proteins in eukaryotic cells.

Canine cadaveric study of flexor tendon repair using tendon splint: tensile strength and the work of flexion

A total of 128 flexor tendon repairs in zone II were performed with various suture techniques using a canine cadaver model to determine the tensile strength, gap strength, and resistance to tendon gliding as measured by the work of flexion. The ultimate tensile strength in kilogram force (kgf) following tendon laceration and repair was the greatest after repair by the Savage technique (4.84 kgf) and the dorsal tendon splint technique (4.89 kgf), while the standard Kessler technique showed a strength of only 1.48 kgf. The greatest gap strength values were also obtained for the Savage and dorsal tendon splint techniques. The work of flexion increase was the greatest at 85.5% after repair using a mesh sleeve technique. While, the Savage and dorsal tendon splint techniques showed an increase of 24.3% and 25.1% with no significant difference compared to the other technique studied. Considering the values of these biomechanical parameters, we believe that the best flexor tendon repair techniques in the canine model are the Savage and dorsal tendon splint.

[MR imaging of intramuscular hemangiomas]

Magnetic resonance images of eight surgically confirmed intramuscular hemangiomas were correlated with the pathologic findings. T1- and T2-weighted images were obtained in all cases; STIR images were also obtained in six cases, and fat-suppressed enhanced images in seven cases. All eight hemangiomas showed markedly high signal intensity on T2-weighted images. Linear and round low-signal-intensity components within hemangiomas corresponded to fibrous tissues, high flow vessels and phleboliths. Fat-suppressed enhanced images were superior to images without fat suppression in defining the extent of lesions. STIR images were useful in defining the extent of hemangiomas with infiltration into surrounding tissues. MRI is useful for distinguishing intramuscular hemangiomas from other soft tissue tumors and also supplies valuable information about the extent of the lesions.

The eighth Cct gene, Cctq, encoding the theta subunit of the cytosolic chaperonin containing TCP-1

The chaperonin containing t-complex polypeptide 1 (TCP-1), as one of its subunits, CCT, is a cytosolic heterooligomeric molecular chaperone assisting in the folding of proteins in eukaryotic cytosol. We have isolated a Tcp-1-related 119-bp cDNA fragment from a human cDNA library by polymerase chain reaction, and cloned full-length mouse cDNAs orthologous to the human cDNA by hybridization. The nucleotide (nt) sequence of the longest mouse clone (1844 bp) shows an open reading frame (ORF) encoding a TCP-1-related polypeptide of 548 amino acids (aa) (59,562 Da). This gene is different from Tcp-1 and the six Tcp-1-related genes reported previously, Tcp-1 (Ccta), Cctb, Cctg, Cctd, Ccte, Cctz and Ccth, which encode subunits of CCT. The product of the novel gene was analysed using an antibody raised against the C terminus of the polypeptide deduced from the nt sequence. We found that this gene encodes a subunit of CCT (polypeptide S1; 62 kDa and pI 6.25 by two-dimensional gel analysis). We have named it Cctq, encoding the theta subunit of CCT (CCT theta). The aa sequence of CCT theta shows 23-29% identity to the other CCT subunits, alpha, beta, gamma, delta, epsilon, zeta and eta, and 29% identity to the archaebacterial chaperonin TF55. CCT theta also contains the motifs common to all the other subunits of CCT which are postulated to be involved in ATPase activity.

Fracture of the posterior medial tubercle of the talus treated by internal fixation: a report of two cases

A fracture through the posterior medial tubercle of the talus is quite rare. Although excision of the bone fragments has been reported previously in this fracture, cases of internal fixation of the posterior medial tubercle of the talus have not been reported. Two patients are described who presented with a fracture through the posterior medial tubercle of the talus which was treated with internal fixation. Our patients appeared normal on physical examination and returned to work, with no evidence of avascular necrosis of the fragments.

[The left-sided atrioventricular replacement of corrected transposition of the great arteries through a left thoracotomy]

In a 17-year-old female with dextrocardia and corrected transposition of the great arteries, whose VSD and PFO had been surgically closed through median sternotomy two years previously, the left-sided atrioventricular valve replacement was performed for its severe insufficiency. The left anterolateral thoracotomy was chosen to have good visual field and to prevent unnecessary dissection of the adhesion. The postoperative course was uneventful.

HTLV-I-associated myelopathy: analysis of 213 patients based on clinical features and laboratory findings

We studied the clinical features and laboratory findings in 213 patients with HTLV-I-associated myelopathy/tropical spastic paraparesis as diagnosed in Kagoshima University Hospital. Some aspects of clinical features in HTLV-I-associated myelopathy/tropical spastic paraparesis were characterized by mode of HTLV-I transmission and age of onset. The patients with onset after 15 years old and no history of blood transfusion before the onset of the disease (151 patients, group I) showed a shorter interval between the time of disease onset and that of inability to walk. The patients with onset before 15 years old and without history of blood transfusion (21 patients, group II) had short stature and slow progression of the disease. The interval time and the progression of the disease in patients with history of blood transfusion before onset of disease (41 patients, group III) were in between those of the above two groups. Patients whose ages of onset were older than 61 years old showed a faster progression than those with younger onset regardless of the mode of HTLV-I transmission. HTLV-I-associated myelopathy/tropical spastic paraparesis patients often also showed other organ disorders such as leukoencephalopathy (69%), abnormal findings on chest X-ray (50%), Sjögren syndrome (25%) and arthropathy (17%). The patients with low anti-HTLV-I antibody titers in the cerebrospinal fluid (2X-8X by PA method) had an older age of onset on average, milder clinical symptoms and lesser increase of neopterin in the cerebrospinal fluid than those in the high titer subgroup whose titers were higher than 1024X in cerebrospinal fluid regardless of the mode of HTLV-I transmission. We speculate that the clinical course of HTLV-I-associated myelopathy/tropical spastic paraparesis mainly shows a slow progression which consists of an initial progressive phase (probably an inflammatory phase) and a latter chronic phase, although some patients showed acute/subacute onset and rapid progression.

Cirrhotic livers can tolerate 30 minutes ischaemia at normal environmental temperature

OBJECTIVE

To find out the safe time limit for Pringle's manoeuvre (compression of the hepatic artery and portal vein in the gastrohepatic omentum to halt bleeding) under normal environmental conditions for limited resection of cirrhotic livers.

DESIGN

Prospective open study.

SETTING

University hospital, Japan.

SUBJECTS

Pringle's manoeuvre was used in 73 consecutive patients with hepatocellular carcinoma and cirrhosis (Child's classification: A = 44, B = 24, and C = 5), and in 20 patients it was not used (Child's classification: A = 11, B = 5, and C = 4).

INTERVENTIONS

Limited hepatic resections were done with the duration of Pringle's manoeuvre ranging from 5 to 41 minutes. 15 patients simultaneously underwent 17 other abdominal operations.

MAIN OUTCOME MEASURES

Child's classification, blood loss during operation, and duration of hepatic ischaemia.

RESULTS

The morbidity and mortality with Pringle's manoeuvre were 1 (2%) and 0 in Child's A cirrhosis, 7 (29%) and 2 (8%) in Child's B cirrhosis, and 2 (40%) and 1 (20%) in Child's C cirrhosis. The higher rates in class B and C patients were ascribed to the amount of blood loss rather than to Pringle's manoeuvre.

CONCLUSION

Pringle's manoeuvre can be used safely for up to 30 minutes during limited resection of the cirrhotic liver.

[Familial early onset cerebellar ataxia with hypoalbuminemia]

We describe two brothers with early onset cerebellar ataxia associated with hypoalbuminemia (EOCAH). Choreo-athetoid movements preceded the cerebellar ataxia, and serum pseudocholinesterase elevation preceded the hypoalbuminemia. The parents are first cousins. Patient 1, the 22-year-old elder brother, developed choreoathetoid movements of the neck and extremities at the age of eighteen months. He later developed slowly progressive cerebellar ataxia with decreased tendon reflexes. The choreoathetoid movements ceased at about 16 years of age. A recent examination revealed cerebellar ataxia, action myoclonus of the neck and upper limbs, diminished tendon reflexes, mild sensory disturbance in the lower extremities, and very slight amyotrophy of the feet. Patient 2, the 18-year-old younger brother, developed choreo-athetoid movements at the age of 6 years, followed by slowly progressive cerebellar ataxia with disminished tendon reflexes. No scoliosis, ECG abnormalities, or edema was detected. Serum biochemistry studies revealed elevated pseudocholinesterase (6,226 to 2,390 IU) in the patient's early teens. Serum albumin levels tended to be low (3.7 to 4.1 g/dl). Serum triglyceride and beta-lipoprotein levels were elevated in the patients' late teens. Genetic studies showed slight linkage of D9S15. The maximum lod score was 0.289 (recombination fraction rate was 0.14).

Effect of suture knots on tensile strength of repaired canine flexor tendons

59 dog cadaver flexor digitorum profundus tendons were repaired with one or two knots inside or outside the tendon, using two, four and six suture strands. The ultimate tensile strength and gap strengths were compared. Locating the knots outside rather than within the tendon repair site showed significantly higher ultimate tensile strength for two, four, and six strand sutures. The strength was greater in one knot than in two knot sutures; the value of the six-strand suture using the one knot outside technique was the greatest. Similarly, increased gap strength was also obtained from the one-knot-outside technique. We concluded that the knots should be located away from the tendon repair site and there should be as few as possible.