Compulsory superselective arterial embolization in hypovascular local hepatic tumor ablation. Microballoon coaxial catheterization

We performed compulsory superselective transcatheter arterial embolization on local hypovascular liver metastases under balloon occlusion using a 1-mm (3 F) coaxial microballoon catheter in 2 cases. One case was a metastasis from breast cancer (maximum diameter 5.5 cm) at segment 7. The other case comprised metastases from rectal cancer (maximum diameter 8 cm) at segments 7 and 8. Absolute ethanol (50%) mixed with Lipiodol (50%) was used for embolization. No major treatment-related complications occurred. No local recurrence was observed in either case in follow-up CT and MR studies of up to 16 and 9 months respectively. This technique may thus be applied as an alternative to surgical resection in the treatment of local hypovascular liver tumors.

[Comparison of side effects caused by intra-arterial and intravenous infusion of M-VAC (methotrexate, vinblastine, adriamycin and cisplatin) for urothelial cancer]

We retrospectively studied the toxic effects in 14 patients with urothelial cancer who had undergone intra-arterial M-VAC chemotherapy (Group A) and 13 patients who had received intravenous M-VAC chemotherapy (Group V) between February 1991 and August 1995. No statistically significant differences were found in the white blood cell count nadir, liver function, renal function or appetite between the groups. While the platelet count nadir for intra-arterial infusion (14.0 x 10(4)/mm3) was larger than for intravenous infusion (9.0 x 10(4)), the median days to nadir for this count was shorter in the intra-arterial group (9.1 days) than in the intravenous group (13.5). In addition, the difference between the beginning hemoglobin level and the nadir level was larger in the intra-arterial infusion group (2.55 g/dl) than in the intravenous infusion group (1.95 g/dl). Additionally peculiar side effects were noted in the intra-arterial infusion group which included local erythema and nerve paralysis. Side effects should be managed for intra-arterial M-VAC as well as for intravenous infusion.

New 3-dimensional mapping device for cystoscopy

PURPOSE

The crucial shortcoming of cystoscopy is that it does not measure the size of observed objects, and so we developed a new device that adds measurement capability to the cystoscope.

MATERIALS AND METHODS

The device consists of 5 arms linked to each other by freely bending joints. Before use 1 end of the arm is fixed to the examination table and the other end is linked to the eyepiece of the cystoscope. While linked to the arms, the cystoscope can move freely in any direction. Each joint carries an accurate sensor to measure its angle. The angle measurements are calculated collectively to obtain the 3-dimensional coordinates at the tip of the cystoscope. The tip of the cystoscope can be moved to the other side of the objects to be measured, which provides a pair of 3-dimensional coordinates, because the distance between them can be calculated.

RESULTS

We could calculate the distance between the bladder neck and each ureteral orifice, and the angle of the bladder neck formed with the left and right orifices in clinical cases. By continuous measurement of the location of the bladder neck and the ureteral orifice, it was clearly demonstrated that the distance between them increased as the bladder filled.

CONCLUSIONS

Our computer assisted, 3-dimensional mapping device can replace unreliable cystoscopic assessment with more reliable numerical values. New diagnostic criteria based on the exact numerical values can be established with the use of this device.

[CT-ventriculography: a new application of the helical CT]

The authors proposed a new application of helical CT, namely, CT-ventriculography that can obtain 2D and 3D images of different cardiac phases. CT-ventriculography could assess wall motion, systolic thickening and chamber volume. From a single breath hold helical CT 50-rotation), about 500 transaxial slices were obtained by applying overlapping reconstruction (0.1 pitch, 0.08 sec = 0.2 mm interval). All transaxial slices were recordered to separate different cardiac phases. Then, long and short axial 2D tomograms and 3D images in different cardiac phases were reformatted. CT-ventriculography is a promising new application for the assessment of heart function.

Naive and memory T cell infiltrates in chronic hepatitis C: phenotypic changes with interferon treatment

The phenotypes of infiltrating lymphocytes in liver with chronic hepatitis C, including changes associated with interferon (IFN) treatment, were characterized. Specimens obtained from 22 patients treated with IFN were examined using avidin-biotin-peroxidase immunohistochemistry. In areas of lobular and periportal inflammation, most lymphocytes were CD8+ T cells of the CD45RO+ (memory) subset. The centres of lymphoid follicles were occupied by CD20+ B cells and a few CD4+ T cells which were CD45RA+ (naive subset). Follicular centres were surrounded mainly with CD4+ T cells. CD8+ T cells, mostly CD45RO+, were scattered through the mantle zones of follicles and extended around them. No significant changes in CD45RA+ lobular infiltrates accompanied IFN treatment. On the other hand, the number of CD45RO+ lobular infiltrates decreased after IFN treatment in complete responders (P < 0.01). Moreover, there were significant correlations between CD45RO+ cell counts and serum alanine aminotransferase concentrations, CD45RO+ cell counts and the liver histologic grade and CD45RO+ cell counts and CD8+ cell counts. These results suggest that CD8+ memory T cells participate in hepatocyte injury in chronic hepatitis C, and that a decrease of CD8+ memory T cells correlates with the decreased liver inflammation with IFN treatment.

Disappearance of unilateral spatial neglect following a simple instruction

OBJECTIVES

To clarify the reason why patients with left unilateral spatial neglect fail to copy the left side of a daisy like flower, not continuing to draw petals all around.

METHODS

A flower was simplified and a figure was made that consisted of a large central circle and small circles surrounding it. Four patients with typical left unilateral spatial neglect performed copying and arrangement tasks to make this figure. In the arrangement task, they were instructed to arrange small circles all around the printed central circle.

RESULTS

The patients' identification of the composition seemed flawless. In the copying task, they showed neglect, leaving a space on the left side. They seemed to adhere to their plan to place the same number of small circles as those of the model figure. By contrast, neglect disappeared in the arrangement task.

CONCLUSION

Patients with neglect can draw the figure satisfactorily if they use a spatial strategy to arrange small circles all around. This strategy seems to improve motivation for drawing and awareness for the left space. It is considered that in the copying of figures such as a daisy, failure to use a spatial strategy plays an important part in the appearance of left unilateral spatial neglect.

Second primary cancers following non-Hodgkin's lymphoma in Japan: increased risk of hepatocellular carcinoma

We evaluated the risk of development of second primary cancers, with particular reference to subsequent hepatocellular carcinoma (HCC), in 592 patients diagnosed as non-Hodgkin's lymphoma (NHL), at Osaka Medical Center for Cancer and Cardiovascular Diseases. During 1978-1994, 2,163 person-years of observation were accrued, and 27 of the patients developed a second primary cancer, yielding an observed-to-expected ratio (O/E) of 1.53 [95% confidence interval (CI) = 1.01-2.23]. Significant excess risk was noted for primary liver cancer (PLC; O/E = 4.36, 95% CI = 1.99-8.28; O = 9) and non-lymphocytic leukemia (O/E = 26.17, 95% CI = 5.26-76.46; O = 3). The excess risk of PLC was relatively constant within the first 10 years after the NHL diagnosis. Patients who received chemotherapy as the NHL treatment had a significantly increased risk of PLC (O/E = 5.91, 95% CI = 2.70-11.23; O = 9). Their clinical reports indicated that all nine patients with PLC were diagnosed as HCC, and eight of them had clinical and/or histologic evidence of cirrhosis at the time of HCC diagnosis. None of the nine patients had a history of blood transfusion between the first NHL treatment and the diagnosis of HCC. These findings suggested that Japanese NHL patients might have an increased risk of developing HCC, and they indicated the importance of medical surveillance for liver malignancies, as well as subsequent leukemias. Possible explanations for the excess risk of subsequent HCC are discussed.

[Prognosis of renal cell carcinoma coexisting with renal cystic diseases--results of nation-wide survey in Japan]

OBJECTIVE

To study the outcome of the patients with renal cell carcinoma (RCC) coexisting with renal cystic disease.

SUBJECTS AND METHODS

The nation-wide survey conducted in 1989 enrolled 223 patients with RCC coexisting with renal cystic disease. Of those 223, we could follow up 216 patients in the second survey in 1994.

RESULTS

Renal cystic diseases coexisting with RCC included simple renal cysts in 69 cases, acquired cystic disease of the kidney (ACDK) in 61, cystic RCC in 54, multilocular renal cysts in 19, polycystic kidney in 3, miscellaneous cysts in 9, and unspecified cyst in 1. The overall 5-year survival was 84%. The mean survival of the patients without any symptoms was significantly higher than that of those with symptoms. The survival of those with ACDK was lowest, and that will cystic RCC was highest. The survival was significantly different between the two groups, however the disease specific survival excluding the effect of dialysis was not significantly different between the two groups. Regarding TNM category, those with pT1 or pT2, comprising 87% of the subjects, carried a prognosis more favorable than those with pT3 or pT4. Among those undergoing cyst puncture (47 patients), positive cytology resulted in poorer prognosis. However, there was no such difference in the prognosis between punctured group and non-punctured group.

CONCLUSION

Those with RCC coexisting with renal cystic disease carried a favorable prognosis. Cyst puncture were not concluded to exert an unfavorable effect on the prognosis at least in this study.

Acute myocardial infarction due to vasospasm in a 13-year-old-boy

We describe an unusual case of acute myocardial infarction due to vasospasm in a 13-year-old boy. He was admitted to our hospital with severe congestive heart failure and shock. He had experienced a feeling of chest oppression with dyspnea while running, which grew worse. He then lost consciousness and was brought by ambulance to our intensive care unit. He had had similar but milder episodes of chest oppression months earlier. The family history revealed that his father had died suddenly from hypertrophic cardiomyopathy and that his grandmother also had hypertrophic cardiomyopathy. On admission, the patient was bathed in a cold sweat, his pulse was weak, and his blood pressure was too low to measure. Coarse crackling and wheezing were audible in both lung fields. Administration of catecholamine and intra-aortic balloon pumping failed to stabilize the hemodynamic variables, but percutaneous cardiopulmonary support proved to be lifesaving. Coronary arteriography performed during his convalescence showed on evidence of atherosclerosis. The acetylcholine provocation test ultimately revealed a diagnosis of acute myocardial infarction due to vasospasm.

Characterization of Orientia tsutsugamushi isolated in Taiwan by immunofluorescence and restriction fragment length polymorphism analyses

A total of 10 strains of Orientia tsutsugamushi were isolated from field rodents and chiggers in Taiwan, and characterized by immunofluorescence analysis with monoclonal antibodies and by restriction fragment length polymorphism analysis of the 56-kilodalton (kDa) protein gene. The isolates were divided into two groups consisting of 1 and 9 strains which showed some relation to Gilliam and Karp type strains, respectively. However, all these isolates possessed characteristics distinct not only from those of known prototype strains including Gilliam and Karp but also from all isolates from Japan. These findings suggest the existence of a large number of immunotypic and genotypic variants among the strains of O. tsutsugamushi, and the distribution of distinguishable strains in each area to which this species is endemic.

Effect of immunosuppression on composition of quasispecies population of hepatitis C virus in patients with chronic hepatitis C coinfected with human immunodeficiency virus

BACKGROUND/AIMS

To study the effects of the immunosuppression caused by the reduction of CD4 activity on the composition of hepatitis C virus (HCV) populations, we analyzed the number of HCV quasispecies clones and the nucleotide diversity of the hypervariable region 1 (HVR1) of HCV in 37 patients with hemophilia with persistent HCV infection, with or without human immunodeficiency virus (HIV).

METHODS

The numbers of HCV quasispecies clones were measured by fluorescence single-strand conformation polymorphism analysis. Direct sequencing was used to analyze the degree of diversity of HVR1. We compared these values according to coinfection with HIV, and CD4 counts of patients.

RESULTS

There were no differences in either the number of HCV clones or the diversity between patients with and without HIV coinfection. In HIV coinfected patients the diversity decreased in association with the decrease in CD4 count while the number of HCV clones did not. The diversity of HVR1 was 3.64 +/- 5.03% in patients with a CD4 count < 50/microliters and 14.92 +/- 6.03% in patients with a CD4 count > or = 50/microliters; it was significantly lower in the former (p = 0.0002).

CONCLUSIONS

A severe reduction in the CD4 count, which is considered to cause a decline in the activity of helper T-lymphocytes, induced changes in the composition of HCV populations; one or a few quasispecies clones are predominant in the HCV population in the serum of individual patients.

Endothelins promote the activation of astrocytes in rat neostriatum through ET(B) receptors

The effects of endothelin (ET)-3 and an ET(B) receptor agonist on astrocytic activation in rat caudate putamen were examined by an immunohistochemical staining of glial fibrillary acidic protein (GFAP), a marker of reactive astrocytes. A single injection of 40 pmol ET-3 into rat caudate putamen increased the number of GFAP positive cells compared to that in the contralateral saline-injected side. Ala(1,3,11,15)-ET-1 (40 pmol), an ET(B) receptor agonist, also increased the number of striatal GFAP positive cells. The increases in GFAP positive cells were maximum (about 150% of the control side) in 1-2 weeks after injections of the ETs, and then reduced in 4 weeks. A continuous infusion of BQ788, an ET(B) receptor antagonist (23 nmol/day), into the lateral ventricle of the cerebrum antagonized the effect of Ala(1,3,11,15)-ET-1, while BQ788 also reduced the number of GFAP positive cells in saline-injected caudate putamen. Intrastriatal injection of 40 pmol Ala(1,3,11,15)-ET-1 did not affect the number of cells stained by B4 isolectin from Griffonia simplicifolia, which labels activated microglia/macrophages. Intraperitoneal administration of 5 mg/kg per day chloroquine and 0.2 mg/kg per day colchicine did not affect the action of Ala(1,3,11,15)-ET-1. These results suggest that activation of ET(B) receptors is involved in the induction of reactive astrocytes.

[Primary carcinoma of the female urethra: report of five cases]

Between 1988 and 1996, we treated five patients with primary carcinoma of the female urethra between 65 and 79 years of age. Presenting symptoms included a urethral mass in 2 patients, hematuria in 1, dysuria in 1 and urethral bleeding in 1. Histopathology revealed squamous cell carcinoma in 4 cases and transitional cell carcinoma in 1. Clinical stage according to Grabstald's classification comprised Stage A in two cases, Stages B, C and D in one each. The modes of treatment were surgical resection alone in two, radiation therapy alone in two, and surgery with adjuvant chemotherapy in one case. Three patients without disease and two with disease are olive from 5 to 87 months after diagnosis.

[Second primary cancers occurring in patients with cancers of the mouth and meso-hypo pharynx in Japan]

We evaluated the risk of development of a second primary cancer in 669 patients diagnosed with cancers of the mouth and meso-hypo pharynx at Osaka Medical Center for Cancer and Cardiovascular Diseases. During 1978-93, 70 of the patients developed a second primary cancer, yielding on observed to expected ratio (O/E) of 2.92 [95% confidence interval (CI) = 2.27-3.69]. Significant excess risk was noted for cancers of mouth and pharynx (O/E = 12.01, 95% CI = 3.87-28.04), esophagus (O/E = 25.22, 95% CI = 14.94-39.86), colon (O/E = 3.85, 95% CI = 1.41-8.39), larynx (O/E = 9.93, 95% CI = 2.00-29.02) and lung (O/E = 2.58, 95% CI = 1.24-4.75). The risks of esophageal cancer and colon cancer were significantly elevated after five years had elapsed from the initial cancer diagnoses. The risk of cancers of the oral cavity, pharynx, larynx and esophagus in patients who had a history of current smoking without current daily drinking at the initial diagnosis was elevated past one year after the initial diagnosis (less than 20 cigarettes/ day; O/E = 12.50, 95% CI = 0.16-69.55, 20 cigarettes or more; O/E = 10.00, 95% CI = 1.12-36.10). The risk of cancers of the oral cavity, pharynx, larynx and esophagus in patients who had a history of current smoking with current daily drinking at the initial diagnosis was around two times higher than those who had a history of current smoking without current daily drinking (less than 20 cigarettes/day; O/E = 20.00, 95% CI = 2.25-72.21, 20 cigarettes or more; O/ E = 19.51, 95% CI = 8.40-38.45).

[Activation and cell death of astrocytes]

The mechanism of induction of reactive astrocytes (activation of astrocytes) that is observed in brain pathological conditions is not fully elucidated, and there is little information on the cell death of astrocytes. This mini-review summarizes our studies on the activation and cell death of astrocytes. Microinjection of endothelin-3 or the endothelinB-receptor agonist ala1,3,11,15-endothelin-1 enhanced the injury-induced increase in glial fibrillary acidic protein staining in rat neostriatum. Under these conditions, the receptor agonist did not affect the number of microglia/macrophage. The findings suggest that the signal cascade via endothelinB receptors in astrocytes is involved in induction of reactive astrocytes. We also found that Ca2+ depletion followed by reperfusion with Ca(2+)-containing medium caused cell death in cultured astrocytes (Ca2+ paradox-like injury). The study, carried out by the use of a specific antisense oligomer, provides direct evidence that Ca2+ paradox-like injury is mediated by the Na(+)-Ca2+ exchanger in the reverse mode. The injury was prevented by inhibitors of the Na(+)-Ca2+ exchanger and heat shock protein. Heat shock protein may affect processes downstream of the increase in intracellular Ca2+ concentration. Further studies on activation and cell injury of astrocytes will contribute to the development of new drugs that modulate the function of astrocytes.

[Clinical statistics on in-patients and operations during a 20-year period (1975-1994) at Department of Urology, Kansai Medical University]

The patients, diseases and operations experienced between 1975 and 1994 in our department were statistically analyzed. The numbers of in-patients and operations have been increasing since 1977. During these 20 years, endoscopic surgery has replaced many open surgical procedures. The introduction of extracorporeal shock wave lithotripsy has dramatically changed the therapeutic modality for urolithiasis, and decreased of the necessity of open surgery.

Regulation of interleukin (IL)-1beta gene transcription induced by IL-1beta in rheumatoid synovial fibroblast-like cells, E11, transformed with simian virus 40 large T antigen

OBJECTIVE

To investigate the process involved in the production of and responsiveness to interleukin 1beta (IL-1beta) in synovial fibroblast-like cells, we analyzed the enhancer region of pro-IL-1beta gene in a cell clone, E11, established from a patient with rheumatoid arthritis (RA).

METHODS

A cell clone, E11, was derived from rheumatoid synovial fibroblast-like cells transformed with simian virus 40 large T antigen expression vector by electroporation. Responsiveness of E11 to IL-1beta was analyzed by [3H] thymidine incorporation and Northern blotting. IL-1beta responsive elements on pro-IL-1beta gene were analyzed by chloramphenicol acetyltransferase analysis.

RESULTS

E11 resembled synovial fibroblasts based on morphological characteristics and phenotypic analysis. It also demonstrated marked enhancement of proliferation and rapid induction of IL-1beta mRNA expression by IL-1beta. We also identified IL-1beta responsive elements on the pro-IL-1beta gene at a position between -3134 and -3092 that contains the AP-1 binding site and between -2782 and -2729, which includes both AP-1 and nuclear factor-kappaB (NF-kappaB) binding sites.

CONCLUSION

AP-1 and NF-kappaB binding elements were required for transcriptional regulation of the IL-1beta gene in the autocrine growth system of RA synovial cells.

Induction of glutamine synthetase by L-alpha-aminoadipate in developmental stages of cultured astrocytes

Effect of L-alpha-aminoadipate (L alpha AA), a gliotoxic L-glutamate analogue, on glutamine synthetase (GS) activity of rat cultured astrocytes was examined, L alpha AA at sub-toxic concentrations (less than 0.5 mM, for 48 h) increased GS activity of cultured astrocytes. This increase was prevented by 10 microM cycloheximide, an inhibitor of protein synthesis. L alpha AA increased GS activities of astrocytes cultured in three different conditions, i.e. 12-day-old, 5-233k-old and dibutyryl cAMP(DBcAMP)-induced differentiated cultures. Insulin (10 micrograms/ml) and hydrocortisone (10 microM) increased GS activity of 12-day-old cultured cells, but not that of 5-weeks-old and DBcAMP-treated cells. The increase in GS activity was observed after a transient treatment with L alpha AA for 4 h. These results show that the induction of GS by L alpha AA is not related to developmental stages of astrocytes in culture.

Neurotropic pyrimidine heterocyclic compounds. II. Effects of novel neurotropic pyrimidine derivatives on astrocytic morphological differentiation

Astrocytes play an important role in supporting nerve regeneration after brain injuries. In this study, the effects of novel neurotropic synthesized pyrimidine compounds on astrocytic morphological differentiation were examined. Treatment of protoplasmic cultured astrocytes with 2-piperidino-5,6-dihydro-7-methyl-6-oxo(7 H)pyrrolo[2,3-d]pyrimidine maleate (MS-430) and the related compounds caused astrocytic process formation in 60 min. The morphology of MS-430-treated cells was similar to that of dibutyryl cAMP (DBcAMP)-treated cells. The astrocytic process formation by MS-430 was observed within 60 min and the maximum effect was obtained at the drug concentration of 0.5-1.0 mM. Rhodamine-phalloidin staining showed that astrocytic cytoskeletal actin was reorganized by MS-430 and DBcAMP. MS-430 did not increase cAMP accumulation in cultured astrocytes. These results suggest that the neurotropic pyrimidines induced astrocytic morphological differentiation through a cAMP-independent mechanism.

[Anesthesia for pediatric open heart surgery without transfusion]

We reviewed 50 recent anesthetic managements of pediatric patients for open heart surgery weighing between 6.5 to 12 kg to evaluate factors contributing to successful management without transfusion. Twenty six cases were managed without transfusion, whereas nine cases required less than 30 ml.kg-1 of transfusion and the other 15 cases needed massive transfusion amounting to more than 50 ml.kg-1. The followings are important factors to complete the open surgery without transfusion; 1) the patient's weight is 9 kg or more, 2) the duration of cardiopulmonary bypass is less than 120 minutes, and 3) intraoperative bleeding is less than 10 ml.kg-1. We could find several advantages in patients without transfusion, compared with those receiving transfusion, such as greater urine output, less bleeding during the surgery, more concentrated platelet and better respiratory condition after the surgery. In addition, the lager the amount of transfusion we observed the more disadvantageous to the patients. Even if transfusion can not be avoided, minimal transfusion of the washed red cell is favorable.