Jumping translocations of 1q in Burkitt lymphoma and acute nonlymphocytic leukemia

"Jumping translocations" have been observed mostly in cultured cells. Reports of such translocations in hematologic malignancies are few, and the associated clinical picture is unclear. We report three cases of hematologic malignancies with various unbalanced translocations (so-called jumping translocation) involving trisomy of the long arm of chromosome 1. The first case was a 13-year-old boy with Burkitt lymphoma who showed a very aggressive clinical course. The second case was a 10-month-old girl with acute nonlymphocytic leukemia [ANNL, French-American-British (FAB) classification M0] who had high risk factors, including hyperleukocytosis with a peripheral white blood cell (WBC) count of 300,000/microliters, and who died 7 months after diagnosis. The third case was a 6-year-old boy with Burkitt-like leukemia whose first remission lasted only 1 month. Only 10 cases with jumping translocations, including two cases with Burkitt-like leukemia/lymphoma, have been reported previously. This rare phenomenon may occur with increased frequency in Burkitt-like leukemia/lymphoma and may be an adverse prognostic factor.

[Anesthetic management for pacemaker implantation of a child with hypertrophic cardiomyopathy and sick sinus syndrome]

A 5-year-old boy weighing 15 kg with hypertrophic cardiomyopathy and sick sinus syndrome was scheduled to undergo implantation of permanent pacemaker without a temporary intravenous pacemaker, because he frequently complained of chest pain and fell into syncope due to hypotension associated with tachycardia when he was agitated. Thus, the most important point in the anesthetic management of this patient was to avoid tachycardia prior to and during general anesthesia. After the patient was premedicated with oral pentobarbital 50 mg and intramuscular morphine 3 mg, he seemed to be calm in the operating room. General anesthesia could be smoothly induced and maintained with halothane, nitrous oxide and fentanyl. During anesthesia, inspired concentration of halothane was chosen on the basis of Q-F time (the time between Q wave on the electrocardiogram and the initial upstroke of arterial pressure wave). The anesthetic course was uneventful. In this case an appropriate preanesthetic medication appeared to be essential, and the measurement of Q-F time was useful for the anesthetic management.

A case of Canavan disease: the first biochemically proven case in a Japanese girl

Canavan disease (CD) has only been diagnosed on autopsy or brain biopsy, however, specific biochemical markers, such as N-acetylaspartic acid (NAA) and aspartoacylase activity, have recently been described in CD. We report a case of CD having the above biochemical markers. High levels of NAA were found in her urine, serum and CSF. Fibroblasts did not exhibit aspartoacylase activity. Clinically, she presented progressive psychomotor retardation, cerebellar signs, pyramidal signs and relative megalencephaly. CT and MRI showed findings of leukodystrophy. The evoked potentials showed widespread involvement in the brainstem. Magnetic resonance spectra showed a high level of NAA in the white matter. In Japan, this case is the first of CD determined on the basis of biochemical markers.

[Cerebral protection during aortic arch replacement: usefulness of continuous O2 saturation monitoring of internal jugular bulb to optimize cerebral perfusion]

How to optimize cerebral perfusion pressure and flow during selective extracorporeal circulation is a crucial problem for cerebral protection in surgical repair of aortic arch aneurysm. Among 47 cases of aortic arch replacement between 1980 and 1992, extracorporeal circulation (ECC) for the first 17 cases [group-1] were hypothermic ECC with selective cerebral perfusion (SCP) and 8 cases [group-2] with hypothermic ECC with hypothermic cardiac arrest. For the latest 16 cases [group-3] we introduced continuous O2 saturation monitoring by oximetry catheter placed in internal jugular bulb (SIJVO2) and maintained SIJVO2 value above 90% to effectively adjust pump flow to optimize cerebral perfusion pressure and flow for cerebral protection. We have retrospectively compared the effectiveness of SIJVO2 monitoring among these three groups. The mortality was 35% (6 cases: group-1), 37% (3 cases: group-2) and 6% (1 case: group-3) respectively. Cerebral dysfunction which were diagnosed in immediate postoperative period were 23% (4 cases: group-1), 0% (0 case: group-2) and 6% (1 case: group-3) respectively. We conclude continuous monitoring of SIJVO2 during selective ECC in aortic arch replacement is useful to optimize cerebral perfusion pressure and flow thereby reducing postoperative cerebral damage by selective ECC.

[Heart rate response to intravenous atropine during cervical and lumbar epidural anesthesia]

The authors evaluated the effect of cervical and lumbar epidural anesthesia on the heart rate response to intravenous atropine 0.01 mg.kg-1 in conscious humans with cervical epidural anesthesia (n = 40), with lumbar epidural anesthesia (n = 15) and without epidural anesthesia (n = 25). During cervical and lumbar epidural anesthesia using 1.5% lidocaine, levels of loss of cold sensation were C3-T7 and T7-S1, respectively. Heart rate increased by 14 +/- 10% (mean +/- SD) and 20 +/- 14% after intravenous atropine 0.01 mg.kg-1 in the patients with cervical and lumbar epidural anesthesia, respectively. These magnitudes of positive chronotropic effects were significantly less as compared with those in the patients without epidural anesthesia (32 +/- 11%). Nine of 40 patients (23%) with cervical epidural anesthesia showed heart rate increases of less than 3 beats.min-1 following atropine 0.01 mg.kg-1. And 30 of 40 patients (75%) required supplementary atropine 0.01 mg.kg-1 to increase heart rate for more than 20 beats.min-1 from baseline values. The present study suggests that the heart rate response to intravenous atropine is blunted in patients during cervical and lumbar epidural anesthesia, and that a larger dose of intravenous atropine may be required to accelerate the heart rate in most patients during cervical epidural anesthesia.

Lumbar epidural anaesthesia prevented prostaglandin E1-induced diuretic effect in enflurane anaesthetized patients

Prostaglandin E1 (PGE1) is used to induce deliberate hypotension during anaesthesia. The purpose of this study was to compare the PGE1-induced diuretic effect in anaesthetized patients with and without lumbar epidural anaesthesia. The changes in haemodynamic variables, urinary flow, one-hour creatinine clearance (Ccr), and fractional excretion of sodium (FENa) during injection of PGE1 or a vehicle were compared in 42 surgical patients during enflurane anaesthesia with lumbar epidural anaesthesia (EPI group) with those in 44 surgical patients during enflurane anaesthesia alone (GA group). Patients in the GA group demonstrated increases in urinary flow (114 +/- 46%) (mean +/- SE), Ccr (74 +/- 26%), and FENa (54 +/- 23%) during PGE1 infusion, which were not observed in the patients in the EPI group. Mean arterial pressure decreased during PGE1 infusion from 92 +/- 3 to 70 +/- 2 mmHg in the GA group (P < 0.01) and from 85 +/- 2 to 65 +/- 1 mmHg in the EPI group (P < 0.01). Plasma antidiuretic hormone concentration during surgery was 12.5 +/- 2.6 U.L-1 in the GA group and 2.3 +/- 0.8 U.L-1 in the EPI group (P < 0.001). It is concluded that PGE1-induced diuresis was prevented by lumbar epidural anaesthesia.

[Growth rates of aortic aneurysms as a risk factor in rupture: an evaluation with CT]

There is a lack of information on the rates of growth of aortic aneurysms. In the present study, the growth rates and survival rates of thoracic and abdominal aortic aneurysms were determined. One hundred seventy-one patients with aortic aneurysm managed nonoperatively have been followed more than 6 months with sequential X-ray computed tomography. The number of aneurysms was 211 (thoracic aortic aneurysm: 82, abdominal aortic aneurysm: 129). The growth rate of thoracic and abdominal aortic aneurysms were 0.42 and 0.28 cm/year, respectively. Aneurysms at the aortic arch (n = 34) grow at a higher average rate (0.56 cm/year) than aneurysms arising at other levels (p < 0.05). The survival rates showed the tendency that the higher the growth rate, the worse the survival rate. The survival rate of aortic arch aneurysm was significantly decreased when the growth rate was higher than the mean value. It is recommended that thoracic aortic aneurysms, especially aortic arch aneurysms, be followed frequently with computed tomographic examination of size.

Single-exposure dual-energy chest images with computed radiography. Evaluation with simulated pulmonary nodules

RATIONALE AND OBJECTIVES

Dual-energy subtraction radiography using computed radiography (CR) can aid in the detection of pulmonary abnormalities such as nodules, but the subtracted image requires higher x-ray exposure than usual to reduce quantum mottle. To reduce quantum mottle without increasing x-ray exposure, a new dual-energy subtraction algorithm was investigated that included an edge-adaptive smoothing process and a subtraction process. The signal-to-noise ratio and the image quality of this new subtracted image was significantly superior to that of conventional subtracted images.

METHODS

Observer performance of the subtracted digital radiography in detecting simulated pulmonary nodules was compared with original CR images and conventional subtracted digital radiography of 50 patients.

RESULTS

A combination of an original CR image and a new subtracted CR image was significantly superior to a single original CR image or a combination of an original CR image and a conventional subtracted CR image (P < .01).

DISCUSSION

The single-exposure dual-energy subtraction method is superior to the conventional subtraction method in the detection of pulmonary nodules.

Development and characterization of a novel anti-fucosylated antigen monoclonal antibody YB-2 and its usefulness in the immunohistochemical diagnosis of colorectal cancer

A novel monoclonal antibody, YB-2 was obtained after immunization of mice with fucosylated antigens isolated from human saliva. The antibody was demonstrated to react with Y (Fuc alpha 1-->2Gal-beta 1-->4[Fuc alpha 1-->3]GlcNAc beta),Leb (Fuc alpha 1-->2Gal beta 1-->3[Fuc alpha 1-->4]GlcNAc beta) and H type 2 (Fuc alpha 1-->2Gal-beta 1-->4GlcNAc beta) antigens, but not with H type 1 (Fuc alpha 1-->2Gal beta 1-->3GlcNAc beta), Lea (Gal beta 1-->3[Fuc alpha 1-->4]GlcNAc beta), X (Gal beta 1-->4[Fuc alpha 1-->3]GlcNAc beta) or with non-fucosylated antigens. Inhibition assays of YB-2 antibody with such reactive antigens showed that YB-2 antibody preferentially reacted with Y antigen. Formalin-fixed and paraffin-embedded sections prepared from normal and malignant colorectal tissues were examined immunohistochemically with YB-2. The positive rates of staining with YB-2 antibody were 88.6% in malignant and 12.0% in normal tissues. The expression of fucosylated antigens detected by YB-2 antibody seemed to be correlated with survival among patients with primary colorectal cancer. Therefore, YB-2 antibody could be useful as an immunochemical tool for diagnosis and evaluation of the prognosis of colorectal cancer.

Steady-state auditory evoked potentials (SSAEPs) in the rabbit. Contribution of the inferior colliculus

Steady-state auditory evoked potentials (SSAEPs) were recorded in rabbits with both surface and depth electrodes. Surface recording from the bregma provided the largest and most typical SSAEPs as compared to other surface locations when a stimulus rate of 50 Hz was used. The medial geniculate body (MGB) showed no potential corresponding to the surface SSAEP. On the other hand, the latency of SSAEP in the inferior colliculus (IC) corresponded closely to that of the surface potential. Furthermore, the amplitude of the IC potential tended to become large with the stimulus rate of 50 Hz as compared with transient stimuli. Although other auditory nuclei in the brain-stem, the ventral nucleus of the lateral lemniscus, the trapezoid body and the auditory nerve responded to transient stimuli with an amplitude larger than that of the IC, no amplification occurred with 50 Hz stimuli in these nuclei. These findings suggest that the IC contributes to the generation of SSAEP to a great extent.

Interpretation of subtle interstitial lung abnormalities: conventional versus storage phosphor radiography

To evaluate the reliability of storage phosphor radiography (SR) in diagnosis of subtle interstitial lung abnormalities, the differences among radiologists in interpreting conventional screen-film radiographs and full-size and minified SR images obtained in 80 patients were studied. Forty patients had subtle interstitial lung abnormalities and 40 had no lung abnormalities. Seven chest radiologists and seven residents evaluated the images by using a five-point presence of abnormality scale. Results were evaluated with receiver operating characteristic technique. For all observers, no significant differences were observed among the three image types. For the chest radiologists, significant differences were observed between conventional radiographs and the two SR formats (P < .01). Furthermore, perceptual accuracy was best with conventional radiographs evaluated by chest radiologists. Overall performance with SR and conventional radiography was identical for diagnosis of abnormalities, but detection performance was significantly dependent on observer experience (P < .01 for chest radiologists and P > .01 for residents). For chest radiologists, critically important information may be lost with commercially available SR.

[The usefulness of a pulse oximeter on the postanesthesia round]

In our hospital, a patient must be transported to one of several types of wards according to the degree of severity of illness (PPC-system). Severely ill patients are surveyed in ICU and HCU with various kinds of monitors. On the contrary, for the patients outside the ICU and HCU wards, the number of monitors is not enough even during postoperative periods. Therefore, we studied the occurrence of hypoxic state of patients with a portable pulse oximeter on postanesthesia round. We surveyed 843 patients during 4 months, and found 79 hypoxemic patients. The number of hypoxemic patients was greater not only after longer operations and anesthesia, but also in obese patients (P < 0.05) as reported previously. Interestingly, we also found more hypoxemic patients in common wards than in ICU and HCU wards. In conclusion, a portable pulse oximeter is a useful equipment in ordinary wards during postanesthesia round.

[Fulminant hepatitis-like veno-occlusive disease of the liver after allogeneic bone marrow transplantation in acute lymphoblastic leukemia]

A 14-year-old girl with acute lymphoblastic leukemia in second remission received an allogeneic marrow graft from her HLA identical brother. Cyclosporine A and short term methotrexate were given for prophylaxis against graft versus host disease. On day 42 post transplantation elevation of SGOT and SGPT was recognized, rising the next day to 8,560IU and 2,590IU, respectively. Prothrombin activity dropped below 10%. HCV antibody and HBs antigen were both negative. Fulminant hepatitis was diagnosed, therefore plasma exchange was initiated. However, hepatic encephalopathy developed and she died on day 57. The postmortem liver appearance was consistent with early changes of veno-occlusive disease. Such atypical cases of VOD with late onset are difficult to distinguish from fulminant hepatitis but should be kept in mind.

[A newly devised endotracheal tube for patients with narrowed trachea]

A 27 year old female patient with pulmonary adenoid cystic cancer was planned for emergency tracheotomy for hemoptysis and severe dyspnea. Six month previously she had a silicon tube (5.5 mm-ID, 40 mm in length) placed in her trachea, because of severe tracheal stenosis. Airway management by endotracheal intubation was deemed necessary during the tracheotomy. However, because of her tracheal narrowing, it was not possible to insert a usual endotracheal tube for adult. First, we made a 4.0 mm-ID endotracheal tube without cuff 12 cm in length (TUBE 1), and a 5.5 mm-ID tube 18 cm in length (TUBE 2). We inserted the TUBE 1 into the TUBE 2, and glued them with Aron-Alpha, making it 25 cm long. We could perform tracheotomy by intubating and wedging this tube into silicon tube.

Oscillatory potentials of visual evoked potentials using source derivation technique in rabbits

The topographic distribution of epidurally recorded flashed visual evoked potentials (VEPs) in unanesthetized rabbits was studied using 2 montages. VEPs with linked ears reference and source derivation were compared. With the linked-ears reference, N34 of VEPs which consisted of slow potentials and superimposed oscillations were recorded diffusely over the head. When source derivation was used, the slow negative potentials of N34 present on the recordings in P3 and P4 were not obtained in F3, Fz and F4. In a digital filtering study of the oscillatory potentials, N34 in oscillatory potentials which were recorded diffusely over the head were localized to the visual cortex by source derivation. It was concluded that N34 in the oscillatory potentials generated from the visual cortex are enhanced and localized with source derivation.

Influence of aging on multi-organ carcinogenesis in rats induced by N-methyl-N-nitrosourea

The effects of aging on the multi-organ carcinogenesis induced in rats by N-methyl-N-nitrosourea (MNU), a direct carcinogen which does not need metabolic activation to exert carcinogenicity, were examined in male F344 rats. In the first experiment, rats at 6, 52, and 98 weeks of age were treated with MNU (20 mg/kg body weight, i.p.) twice weekly for 6 weeks and then maintained without any further treatment for 24 weeks in the case of young and middle-aged rats and for 18 weeks in the case of the old rats. In young rats, malignant lymphomas, particularly thymic types, were observed at significantly high incidence. A striking result in the middle-aged rats was the significantly higher incidence of adenocarcinomas in the small intestine than in young or old animals. The induction of proliferative and neoplastic lesions of the large intestine also tended to be increased in middle-aged rats. In addition, epithelial hyperplasia of the tongue, but not the forestomach, occurred at the highest incidence in the middle-aged group. There were no differences in the induction of epithelial lesions in the urinary bladder among the groups. In a second experiment, investigation of DNA synthesis in the tongue, small and large intestines, urinary bladder and lymph nodes did reveal significant increases or tendency for increase in the MNU-treated groups, but without differences with age. In contrast, the thymus of young rats showed significantly increased incorporation of BrdU label after administration of MNU, whereas it was markedly reduced in middle-aged rats. In a third experiment, O6-methyldeoxyguanine (O6-medG) DNA adduct formation was immunohistochemically detected in various organs including the thymus, forestomach, and small intestine without any differences with age. Thus, the results demonstrated that while the target organs of MNU are modified by the age of the animals, levels of DNA synthesis and O6-medG DNA adduct formation in most cases can not explain the observed differences in carcinogenic susceptibility.

Differences of intravenous nitroglycerin responses in left ventricular systolic and end-diastolic pressures and coronary artery diameters during long-term treatment with cutaneous nitroglycerin patches

The differences of intravenous nitroglycerin responses in left ventricular (LV) systolic and end-diastolic pressures and in coronary artery diameters (cross-tolerance) were investigated in patients receiving nitroglycerin patches. During diagnostic cardiac catheterization, graded doses of 50, 100, and 150 mcg of intravenous nitroglycerin were given. Left ventricular systolic and end-diastolic pressures and left coronary arteriograms were obtained during each dose. Twenty patients with coronary artery disease were studied. Before cardiac catheterization, 10 received nitroglycerin patch (patch group), and 10 did not (control group). In the control group, graded intravenous nitroglycerin doses of 50, 100, and 150 mcg caused decrease in LV systolic pressure of 18 +/- 7%, 20 +/- 5%, and 23 +/- 6%, respectively. In the patch group, the same intravenous nitroglycerin doses decreased LV systolic pressure by 12 +/- 6% (p < 0.05), 19 +/- 7% (NS), and 18 +/- 6% (p < 0.05), respectively, (p value: vs. control group). At the same intravenous nitroglycerin doses, LV end-diastolic pressures were decreased by 48 +/- 14%, 52 +/- 17%, and 56 +/- 9%, respectively, in the control group. However, there were no significant differences in LV end-diastolic pressure between the two groups for any of the three intravenous nitroglycerin doses. The same intravenous nitroglycerin doses caused increase in diameter of the left anterior descending coronary artery and circumflex coronary artery in the control group, which was attenuated significantly in the patch group. Tolerance may develop in LV systolic pressure and coronary artery diameters, whereas it may not develop in LV end-diastolic pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

[Alternative combination chemotherapy with mitomycin C, vincristine, methotrexate, 5-fluorouracil, cis-platinum and adriamycin for adenocarcinoma of the lung]

Efficacy of an alternative combination chemotherapy with MMC, VCR, MTX, 5-FU, CDDP and ADM for adenocarcinoma of the lung is reported. Forty-one advanced cases (stage III: 9; IV: 32) were chosen for the chemotherapy. Two combination chemotherapies MMC + VCR + MTX + 5-FU + CDDP: MVMFP; MMC + VCR + MTX + 5-FU + ADM: MVMFA were repeated alternatively for 8 consecutive weeks with 2 interposed rest weeks, and this regimen was completed in 34 cases. All 41 cases were evaluable. Three and 26 cases achieved complete and partial responses, respectively. The response rate was 70.7%, and the median survival time was 13 months. The adverse effects of the chemotherapy observed were tolerable: alopecia (63.4%), gastrointestinal symptoms (14.5%), bone marrow toxicity (12.2%) and liver dysfunction (4.8%). These results indicate that our MVMFP/MVMFA alternative chemotherapy is quite effective for adenocarcinoma of the lung, comparable or superior to conventional chemotherapies.