Proton magnetic resonance spectroscopy for assessment of human body composition

BACKGROUND

The usefulness of magnetic resonance spectroscopy (MRS)-based techniques for assessment of human body composition has not been established.

OBJECTIVE

We compared a proton MRS-based technique with the total body water (TBW) method to determine the usefulness of the former technique for assessment of human body composition.

DESIGN

Proton magnetic resonance spectra of the chest to abdomen, abdomen to pelvis, and pelvis to thigh regions were obtained from 16 volunteers by using single, free induction decay measurement with a clinical magnetic resonance system operating at 1.5 T. The MRS-derived metabolite ratio was determined as the ratio of fat methyl and methylene proton resonance to water proton resonance. The peak areas for the chest to abdomen and the pelvis to thigh regions were normalized to an external reference (approximately 2200 g benzene) and a weighted average of the MRS-derived metabolite ratios for the 2 positions was calculated. TBW for each subject was determined by the deuterium oxide dilution technique.

RESULTS

The MRS-derived metabolite ratios were significantly correlated with the ratio of body fat to lean body mass estimated by TBW. The MRS-derived metabolite ratio for the abdomen to pelvis region correlated best with the ratio of body fat to lean body mass on simple regression analyses (r = 0.918). The MRS-derived metabolite ratio for the abdomen to pelvis region and that for the pelvis to thigh region were selected for a multivariate regression model (R = 0.947, adjusted R(2) = 0.881).

CONCLUSION

This MRS-based technique is sufficiently accurate for assessment of human body composition.

Renovascular resistance assessed by color Doppler ultrasonography in patients with chronic liver diseases

BACKGROUND AND AIMS

Renal arterial vasoconstriction is known to be related to renal hemodynamic derangement in patients with liver cirrhosis. Using color Doppler ultrasonography in patients with chronic liver diseases, abnormal resistance in the renal artery was examined non-invasively both cross-sectionally and longitudinally to clarify the relationship between renal vascular resistance and liver function to neurohumoral factors.

METHODS

The study comprised 118 patients with cirrhosis, 23 patients with chronic hepatitis, and 35 healthy controls. Pulsatility and resistive indices that were derived from renal artery velocity analysis were used as parameters of renal arterial resistance.

RESULTS

Both the pulsatility and resistive indices were significantly higher in cirrhotic patients (1.29 +/- 0.37, P < 0.001 and 0.69 +/- 0.07, P < 0.001, respectively) compared to controls (1.00 +/- 0.12 and 0.62 +/- 0.05, respectively) and compared to patients with chronic hepatitis (0.97 +/- 0.13 and 0.60 +/- 0.05, respectively). Both indices showed significant correlation with increased Child-Pugh grade. Each correlated significantly with plasma renin activity and plasma aldosterone and norepinephrine levels. Multivariate analysis of the relationship between neurohumoral factors and renal arterial resistance disclosed that plasma renin activity was a significant independent predictor. The longitudinal change in pulsatility index, resistive index and neurohumoral factors were examined in the cirrhotic patients who were followed-up for longer than 6 months. Pulsatility and resistive indices increased according to the deterioration of liver function and the changes in both indices were closely related to the change in plasma renin activity.

CONCLUSIONS

Pulsatility index and resistive index as measured by color Doppler ultrasonography were closely related to the severity of cirrhosis and to the levels of neurohumoral factors, especially plasma renin activity, in this cross-sectional and longitudinal study. Therefore, they are useful indices for assessing renal hemodynamics in patients with cirrhosis.

Antiplatelet action of losartan involves TXA2 receptor antagonism but not TXA2 synthase inhibition

Various AT1 receptor antagonists including losartan are known to inhibit human platelet activation by antagonising TXA2/PGH2 receptors (TP receptors). Presently, we check a hypothesis that losartan, an imidazole derivative in contrast with valsartan, a non-imidazole compound, may inhibit human platelet activation also through inhibition of TXA2 synthesis. Inhibitory action of losartan (2-n butyl-4-chloro-5-hydroxymethyl-1-beta(2'-(1H-tetrazol-5yl)biphenyl-4-yl)methyl] imidazole), its active metabolite EXP 3174 (2-n-butyl-4-chloro-1-beta (2-(1H-tetrazol-5-yl) biphenyl-4-yl) methyl]imidazole-5-carboxylic acid) and valsartan ((S)-N-valeryl-N-(beta2'-(1H-tetrazol-5-yl)biphenyl-4-yl]methyl]valine), on collagen-induced platelet aggregation and TXA2 generation was compared to effects achieved by each compound on U46619-induced aggregation in aspirinized platelets. Losartan and aspirin inhibited collagen-induced platelet aggregation with approximately the same potency, whereas EXP 3174 and valsartan showed much weaker antiplatelet effects. Interestingly, losartan, EXP 3174 and valsartan displayed similar potencies as inhibitors of U46619-induced aggregation in asprinized platelets as in collagen-induced aggregation in non-aspirinized platelets. None of the above three AT1 antagonists, up to a concentration of 300 microM, did influence collagen-induced TXA2 synthesis in human platelets. In conclusion, antiplatelet effects of AT1 antagonists, irrespective of the presence or absence of non-condensed imidazole in their chemical structure, involve antagonism of TP receptors but not inhibition of TXA2 synthesis in platelets.

Plasma matrix metalloproteinase-9 (gelatinase B) in patients with hepatocellular carcinoma

Increased plasma levels of matrix metalloproteinase (MMP)-9 have been shown in cancerous diseases including hepatocellular carcinoma (HCC). Our present aim was to examine whether the measurement of plasma MMP-9 concentration is clinically useful for assessing or monitoring HCC patients. We measured the plasma MMP-9 concentrations in 47 HCC patients, and compared the results with the clinicopathologic features. The plasma MMP-9 levels in patients with HCC were significantly higher than those in the normal controls. The plasma levels of MMP-9 were not related to the size of HCC tumor, the grade of histological differentiation and the serum alpha-fetoprotein level. The plasma levels of MMP-9 were not significantly changed after the effective treatment of HCC tumors. In conclusion, the plasma MMP-9 test was of little value for assessing or monitoring HCC patients.

Fibrosis of liver, pancreas and intestine: common mechanisms and clear targets?

Chronic diseases of the liver, pancreas, intestine, kidneys, skin and lungs are usually accompanied by scarring. Loss of organ function is often progressive despite the use of immunosuppressive, antiviral or antiinflammatory agents. Therefore, well tolerated antifibrotic therapies are urgently needed. The targets for such therapies are activated mesenchymal cells that synthesize an excess of matrix proteins and resemble the myofibroblasts of healing wounds. These cells derive from normally quiescent fibroblasts or smooth muscle cells and from stellate cells of liver and pancreas. Their activation is triggered and maintained by mechanical stress and several fibrogenic modulators and cytokines. Some agents inhibit myofibroblast proliferation and collagen synthesis in vitro, but only few of them are effective in vivo. Potential antifibrotic drugs have been tested mainly in models of liver fibrosis. In the suitable rat model of biliary fibrosis, an antifibrotic effect was demonstrated for silymarin, a defined mixture of flavonoids, and to a lesser degree for pentoxifylline. A spin-off of the large multicenter trials for hepatitis C is the finding that interferon-alpha given for 6-12 months may halt or reverse fibrosis, even in virological non-responders. This has to be proven in prospective randomized trials. Specific inhibitors of the endothelin-A-receptor which are orally available can suppress liver collagen accumulation by 40-60%. Other strategies aim at inhibition of the profibrogenic cytokines TGF-beta or connective tissue growth factor. Effective drug targeting to the fibrogenic liver cells is now possible by use of cyclic peptides that bind to receptors which are specifically upregulated on activated stellate cells. Blockade of such activation receptors can induce stress-relaxation which reverts the fibrogenic cells to a fibrolytic, collagen degrading phenotype. Fibrosis has been discovered as a novel target for the pharmaceutical industry. This implies the use of combinatorial chemistry and an automatized screening machinery, greatly speeding up the design and selection of specific antifibrotic agents. Combined with the rapidly evolving validation of serological markers of fibrogenesis and fibrolysis unforeseen progress in the treatment of organ fibrosis can be expected.

Liver perforation: a serious complication of percutaneous acetic acid injection for hepatocellular carcinoma

A 75-year-old cirrhotic man, after undergoing percutaneous acetic acid injection therapy for hepatocellular carcinoma, presented high fever and right hypochondralgia. Computed tomography disclosed an area of low attenuation in the liver and a crescent-shaped intraperitoneal lesion adjacent to it. We diagnosed liver perforation and localized peritonitis due to the leakage of acetic acid following acetic acid injection. It is important to consider this serious complication when evaluating the indications for percutaneous acetic acid injection for hepatocellular carcinoma.

Comparison between the air displacement method and dual energy x-ray absorptiometry for estimation of body fat

Air displacement plethysmography (ADP) is a method for the determining percent body fat (%BF) using the two-compartment model, in which the body is partitioned into body-fat mass and fat-free mass (FFM). Although this model assumes a constant density of FFM as 1.10 g/ml, its density may depend upon the bone mineral content (BMC) and total body water (TBW) which vary with age, gender, and race/ethnicity. This study compared %BF determined from ADP (ADP%BF) with %BF obtained by dual-energy x-ray absorptiometry (DXA%BF), and also investigated the effects of BMC, TBW, and other factors on its value. The subjects were 721 female and male Japanese aged 40 to 79 years. Body density was measured by ADP and %BF was calculated using Brozek et al's equation. BMC and body-fat volume were measured using DXA, and TBW was measured by multifrequency bioelectrical impedance. A series of anthropometric measurements was taken. Although ADP%BF was highly correlated with DXA%BF (female: r = 0.89, male: r = 0.90) (p < 0.001), ADP%BF differed significantly from DXA%BF (female: -1.30 +/- 0.14% (mean +/- s.e.m.), male: 1.22 +/- 0.13%) (p < 0.001). The difference in %BF (ADP%BF-DXA%BF) was negatively associated with BMC/FFM but not with TBW/FFM in both genders. The difference in %BF was also positively correlated with waist circumference. Considering previous studies, this result may be explained by the underestimation of DXA%BF, rather than by the overestimation of ADP%BF. In conclusion, ADP may be a useful method to measure %BF. However, BMC should be taken into consideration. Furthermore, DXA%BF may be underestimated in people with large waists.

Measurement of relative fat content by proton magnetic resonance spectroscopy using a clinical imager

The aim of this study was to determine the applicability of a proton magnetic resonance (MR) spectroscopy-based technique using a clinical 1.5-T MR imager for assessment of relative fat content. Proton MR spectra were obtained from a trunk phantom and 23 volunteers using a single free induction decay measurement. The ratios of fat methyl and methylene proton resonance to the water proton resonance were compared with the ratio of oil weight to water weight for the phantom, and with the ratio of body fat to lean body mass estimated by bioelectrical impedance analysis for the human subjects. Good linear relationships were found between the MR metabolite ratio and the ratio of oil weight to water weight (r = 0.9989), and the ratio of body fat to lean body mass (r = 0.9169). This MR spectroscopy-based technique is sufficiently accurate and may be applicable to assessment of human body composition.

Predictive factors for intrahepatic recurrence after percutaneous ethanol injection therapy for small hepatocellular carcinoma

BACKGROUND

Percutaneous ethanol injection therapy has been used widely for small hepatocellular carcinoma. This study was undertaken to determine factors predictive of local recurrence or new nodular recurrence in patients with small hepatocellular carcinoma treated with percutaneous ethanol injection.

METHODS

The authors studied 73 nodules treated with percutaneous ethanol injection in 49 patients with small hepatocellular carcinoma. The usefulness of predictive factors for recurrence was assessed with the Kaplan-Meier method. The clinicopathologic variables examined included age, gender, Child-Pugh classification, number of tumors (single vs. multiple), tumor size, degree of tumor differentiation, ultrasonographic findings such as peripheral hypoechoic band (so-called 'halo'), intratumoral echo pattern, tumor staining on enhanced computed tomography, combination therapy with transcatheter arterial embolization, and serum alpha-fetoprotein level.

RESULTS

The local recurrence rates were 19%, 27%, 33%, 33%, and 33%, respectively, and the new nodular recurrence rates were 19%, 51%, 74%, 83%, and 83%, respectively, at 1, 2, 3, 4, and 5 years after percutaneous ethanol injection therapy. The frequency of local recurrence was associated with the histologic differentiation of more than moderately differentiated (P < 0.001), presence of a sonographic halo (P < 0. 005), an intratumoral heterogeneous echo pattern (P < 0.001), and positive tumor staining on enhanced computed tomography (P < 0.01). Multivariate analysis showed that the presence of a halo and an intratumoral heterogeneous echo pattern were the most important variables for predicting local recurrence. The frequency of new nodular recurrences was related to the presence of multiple tumors (P < 0.01) and a high serum alpha-fetoprotein level (P < 0.001). Multivariate analysis showed that a high serum alpha-fetoprotein level was a reliable predictor of new nodular recurrence.

CONCLUSIONS

This study showed that the presence of a halo and an intratumoral echo pattern on ultrasonography were useful predictors for local recurrence after percutaneous ethanol injection therapy for small hepatocellular carcinoma, and that a high serum alpha-fetoprotein level was associated with a higher frequency of new nodular recurrences.

Predictive factors for intrahepatic recurrence after percutaneous ethanol injection therapy for small hepatocellular carcinoma

BACKGROUND

Percutaneous ethanol injection therapy has been used widely for small hepatocellular carcinoma. This study was undertaken to determine factors predictive of local recurrence or new nodular recurrence in patients with small hepatocellular carcinoma treated with percutaneous ethanol injection.

METHODS

The authors studied 73 nodules treated with percutaneous ethanol injection in 49 patients with small hepatocellular carcinoma. The usefulness of predictive factors for recurrence was assessed with the Kaplan-Meier method. The clinicopathologic variables examined included age, gender, Child-Pugh classification, number of tumors (single vs. multiple), tumor size, degree of tumor differentiation, ultrasonographic findings such as peripheral hypoechoic band (so-called 'halo'), intratumoral echo pattern, tumor staining on enhanced computed tomography, combination therapy with transcatheter arterial embolization, and serum alpha-fetoprotein level.

RESULTS

The local recurrence rates were 19%, 27%, 33%, 33%, and 33%, respectively, and the new nodular recurrence rates were 19%, 51%, 74%, 83%, and 83%, respectively, at 1, 2, 3, 4, and 5 years after percutaneous ethanol injection therapy. The frequency of local recurrence was associated with the histologic differentiation of more than moderately differentiated (P < 0.001), presence of a sonographic halo (P < 0. 005), an intratumoral heterogeneous echo pattern (P < 0.001), and positive tumor staining on enhanced computed tomography (P < 0.01). Multivariate analysis showed that the presence of a halo and an intratumoral heterogeneous echo pattern were the most important variables for predicting local recurrence. The frequency of new nodular recurrences was related to the presence of multiple tumors (P < 0.01) and a high serum alpha-fetoprotein level (P < 0.001). Multivariate analysis showed that a high serum alpha-fetoprotein level was a reliable predictor of new nodular recurrence.

CONCLUSIONS

This study showed that the presence of a halo and an intratumoral echo pattern on ultrasonography were useful predictors for local recurrence after percutaneous ethanol injection therapy for small hepatocellular carcinoma, and that a high serum alpha-fetoprotein level was associated with a higher frequency of new nodular recurrences.

Is choledocholithiasis a late complication of nonresectional therapies for hepatocellular carcinoma?

We present 3 patients who developed choledocholithiasis 10, 13, and 12 months after percutaneous ethanol injection and/or transcatheter arterial chemoembolization for hepatocellular carcinoma. Since none of these patients had stones in the gallbladder or in the bile ducts before treatment, bile duct stones might have resulted from local injury in the bile ducts by percutaneous ethanol injection and/or transcatheter arterial chemoembolization. Choledocholithiasis may be a late complication of nonresectional and local therapies for hepatocellular carcinoma tumors.

Serum matrix metalloproteinase-3 (stromelysin-1) concentration in patients with chronic liver disease

BACKGROUND/AIMS

Matrix metalloproteinase (MMP)-3 plays an important role in extracellular matrix degradation, because of its broad substrate specificity and its activation of other proMMPs. Our aims in the present study were to determine whether the measurement of serum MMP-3 is clinically useful for assessing ongoing liver fibrolysis in patients with chronic liver disease.

METHODS

We measured the serum MMP-3 concentrations with a sandwich enzyme immunoassay in 58 patients with chronic hepatitis, 22 patients with liver cirrhosis, 45 patients with hepatocellular carcinoma and 124 healthy individuals. The liver MMP-3 content was also measured in autopsied livers.

RESULTS

Among the healthy controls, the serum levels of MMP-3 were about 2-fold higher in the males than in the females. In this study, the serum MMP-3 results of mainly the male group were analyzed because of the large number of male subjects. Compared to the control level, the mean serum MMP-3 concentration was 55% lower in chronic hepatitis, 53% lower in liver cirrhosis and 46% lower in hepatocellular carcinoma. There was no significant difference in the serum MMP-3 levels among the chronic hepatitis, liver cirrhosis and hepatocellular carcinoma groups. The serum MMP-3 levels were not related to the histological degree of necroinflammation or of liver fibrosis in the patients with chronic hepatitis. No significant difference in serum MMP-3 levels was observed among three Child's subgroups in the group of cirrhotic patients. In the group of patients with hepatocellular carcinoma, the serum MMP-3 levels were not related to the severity of liver function, the HCC tumor size, or the histological differentiation. The serum MMP-3 level was not correlated with serum markers for connective tissue turnover, i.e. procollagen type III peptide, 7S fragment of type IV collagen, hyaluronan and tissue inhibitor of metalloproteinase-1 in the patients with chronic liver disease or hepatocellular carcinoma.

CONCLUSIONS

The measurement of serum MMP-3 is of little use for assessing fibrolysis in chronically diseased livers.

[Case report of muscle cramp versus focal epilepsy]

We report here a boy suffering from muscle cramps in the right upper extremity. At 32 days of age, he developed purulent meningitis followed by paresis of the right upper extremity. From infancy he had intermittent episodes myoclonus-like involving the right hand. Since he also had true epileptic seizures with loss of consciousness, ocular deviation, and vomiting at 6 and 8 years of age, he was treated with anti-epileptic drugs as therapy for focal motor seizures. At 6 years of age, these episodes increased in frequency. The cramps spread from the right hand to involve the entire upper extremity with pain. At the age of 10, he was referred to Hirosaki University Hospital and was admitted. Using closed circuit television with continuous EEG and EMG monitoring we observed during his episodes repeated EMG abnormalities consisting of continuous discharges of polyphasic motor unit potentials, but no epileptic EEG discharges. We diagnosed these episodes as muscle cramp. His muscle cramps were controlled by medication with muscle relaxants and Chinese medicines. This case illustrates that the differential diagnosis between muscle cramps and epileptic seizures is important for proper treatment.

Prognosis for pedunculated hepatocellular carcinoma

We retrospectively compared the outcome of 13 patients at our institution and that of 163 reported cases of pedunculated hepatocellular carcinoma (HCC) with that of conventional HCC subdivided by tumor diameter (group A: less than 2 cm; group B: 2-5 cm, group C: more than 5 cm). The survival of patients with pedunculated HCC in the 163 reported cases was no different from that of group B, but less favorable than in group A (p < 0.01) and more favorable than in group C (p < 0.01). Among the 163 patients with pedunculated HCC, the 113 cases of surgically treated patients had higher survival than the 21 patients treated with transcatheter arterial embolization (n = 16) or transcatheter arterial infusion chemotherapy (n = 5) (p < 0.01) and than 29 conservatively treated patients (p < 0.001). A total of 70 patients out of 163 (42%) died within 1 year after diagnosis. Additionally, almost all cases of pedunculated HCC showed histologically moderately or poorly differentiated characteristics according to Edmondson and Stainer's classification or the WHO classification. These results suggest that pedunculated HCC has not a favorable prognosis if appropriate surgical resection has not been performed very early within a few months because of its rapid progressive nature.

[Effects of a 5-day fast on clinical laboratory data from patients with rheumatoid arthritis]

There have been few studies on the effects of a fast on clinical laboratory data in Japanese. We studied twelve women with rheumatoid arthritis who were not taking any medicine and stayed in the Koda hospital for a diet which lasted 55 days. They basically took a 1200 kcal vegan diet and undertook a 3-5-day fast three times. The clinical laboratory data obtained before and after the second fast (day 27-day 31) were compared. Average body weight decreased by 1.5 kg. There were no changes in CRP. Rapid turnover proteins such as alpha 1 and beta 2-microglobulin decreased, whereas albumin, IgG, IgA and IgM increased. HDL-C increased without a change in LDL-C or triglycerides. Free T3 decreased and free T4 increased, while TSH did not change. The increases in albumin, Ig, HDL-C and free T4 were not consistent with the results of previous studies. This difference may have been due to the low calorie vegan diet before the fast.

[Effects of a low calorie vegan diet on disease activity and general conditions in patients with rheumatoid arthritis]

There is little objective information about diet therapy for rheumatoid arthritis (RA) in Japan. We studied 14 patients with RA who stayed in the Koda hospital for 55 days. They basically took a 1200 kcal vegan diet consisting of unpolished rice gruel, juice of raw vegetables, soya bean curd and sesame seeds, and undertook a 3-5-day fast three times. During the 55-day stay, average body weight decreased by 5.1kg. Lansbury index and ESR decreased whereas CRP did not change. WBC decreased and the differential cell counts showed a decrease of neutrophils, eosinophils and monocytes without a change in lymphocytes or basophils. RBC, hemoglobin and MCV increased. LDL-C decreased, while HDL-C increased. There was no change in total protein or albumin. These data suggest that this combination of a low calorie vegan diet and fasting may contribute to improve RA with little undesirable effects on the patient's general conditions.

[Urine C-peptide excretion in hypocaloric states and factors affecting its excretion]

Recent evidence suggests that hyperinsulinemia may contribute to the development of various risk factors of atherosclerosis. To examine the effects of energy intake on insulin secretion, 24-h urine C-peptide was measured in twelve women with rheumatoid arthritis who were not taking any medicine and stayed in Koda hospital for a diet therapy which lasted 55 days. They were basically placed on a 1200 kcal/day vegan diet combined with three 3-5-day fasting periods (200 kcal/day). Urine C-peptide excretion markedly decreased from 31-40 to 8-14 micrograms/day during the fasting periods. Among the anthropometric variables examined, the average level of urine C-peptide excretions measured in the fasting periods showed a significant correlation with the percentage and the amount of body fat. However, such correlation was not observed while the calorie intake was 1200 kcal. No clinical laboratory parameter showed a significant correlation with urinary C-peptide excretion. These results suggest that the major determinant of urine C-peptide excretion is food intake and that hyperinsulinemia could be easily improved by restricting energy intake.

Limited-stage small cell lung cancer: local failure after chemotherapy and radiation therapy

PURPOSE

To evaluate radiation therapy regimens for improvement in local control in patients with limited-stage small cell lung cancer.

MATERIALS AND METHODS

Radical radiation therapy results in 117 patients with limited-stage small cell lung cancer were retrospectively reviewed. The protocols in 90 patients were 40 Gy in 20 fractions (n = 28), 50 Gy in 25 fractions (n = 32), and 45 Gy in 30 fractions (accelerated hyperfractionation, n = 30). The other 27 patients received thoracic irradiation (dose range, 20-60 Gy; median dose, 54 Gy). All patients underwent systemic chemotherapy.

RESULTS

The 5-year Kaplan-Meier survival rates in the patients with N0, N1, N2, and N3 disease were 26%, 34%, 18%, and 0%, respectively; the rates of in-field relapse were 25%, 36%, 26%, and 25%, respectively; and the rates of marginal relapse were 0%, 9%, 15%, and 29%, respectively. In 56% of patients with marginal relapse, the relapse site was at the upper margin. The 4-year in-field control rates for the patients who underwent 40, 50, and 45 Gy were 51%, 70%, and 56%, respectively.

CONCLUSION

Patients with N3 limited-stage small cell lung cancer should undergo a separate protocol, and the upper margin should be extended in patients with N2 or N3 disease.

[The effects of aging on the relationship between changes in body weight, serum lipid levels, and blood pressure]

The effects of aging on the relationships between changes in body weight, serum lipid levels (total cholesterol, HDL-cholesterol, triglyceride, beta-lipoprotein), and blood pressure (systolic pressure, diastolic pressure) were studied. The subjects were 17,689 Japanese (aged 19 to 88 years) who had received annual examinations at health centers for two consecutive years. After the date were adjusted for sex, body mass index, and serum lipid levels at baseline, changes in serum lipid levels and blood pressure per kilogram change in body weight were estimated for 3 age groups (under 45, 45 to 64, and 65 or older). Positive relationship between changes in body weight and blood pressure were noted for all 3 age groups. Although total cholesterol, triglyceride, and beta-lipoprotein levels all decreased with weight loss in the under-65 groups, total cholesterol in the 65-and-over group did not change significantly. The increases in total cholesterol, triglyceride, and beta-lipoprotein levels were associated with weight gain in the under-65 groups, but not in the 65-and-over group. HDL-cholesterol levels in all age groups decreased significantly with weight gain. These results suggest that aging affects the relationship between changes in body weight and serum lipid levels but not that between changes in body weight and blood pressure.

Post-prandial serum hyaluronan concentration in patients with chronic liver disease

Serum hyaluronan measurement is an option for diagnosing cirrhosis and assessing liver fibrosis, but it is of little use in the diagnosis of chronic hepatitis and compensated liver cirrhosis. It is generally known that intake of food results in elevation of the serum hyaluronan concentration. This work was designed to determine whether a change in the serum hyaluronan concentration after eating might reflect the hepatic sinusoidal endothelial cell impairment in chronic liver diseases. The chronological measurement of serum hyaluronan concentration after eating was performed after an overnight fast in 31 patients with chronic hepatitis, 31 cirrhotic patients, and 8 healthy subjects. The hyaluronan concentration in the loading test increased with the severity of the liver disease in the patients with chronic hepatitis, being significantly higher in the patients with moderate or a higher grade of necroinflammation than in those with a minimal grade, and also significantly higher in patients with stage 3 fibrosis than in those with stage 2 or less. The elevation of the concentration after eating in patients with liver cirrhosis was marked and the range did not overlap with that in patients with chronic hepatitis. Even in 14 patients with compensated liver cirrhosis whose hyaluronan concentration pre-prandially was less than 200 ng/ml, the range of the post-prandial peak concentration did not overlap with that in the chronic hepatitis patients. These results suggest that the evaluation of post-prandial serum hyaluronan concentration is potentially useful for assessing the grading of necroinflammation and staging of fibrosis in patients with chronic hepatitis, as well as for diagnosing compensated liver cirrhosis.

Lung cancer: intermittent irradiation synchronized with respiratory motion--results of a pilot study

PURPOSE

To test the feasibility of a system for intermittent irradiation synchronized with respiratory motion in a clinical setting.

MATERIALS AND METHODS

A newly developed gate pulse controller that starts and stops irradiation at a chosen phase of the respiratory cycle by controlling a linear accelerator was used in six patients with lung cancer. A laser displacement sensor was used for the detection of respiratory motion. Three patients underwent radiation therapy during the cycles between 50% expiration and 50% inspiration (step 1), and three patients underwent radiation therapy during the cycles between 70% expiration and 30% inspiration (step 2).

RESULTS

The system functioned well; irradiation was verified with portal verification radiography in all six patients. The range of the tumor position during synchronized irradiation was detectable with fast portal localization radiography. The treatment times for steps 1 and 2 were 1.38-1.71 and 2.03-2.18 times longer, respectively, than those for conventional irradiation.

CONCLUSION

Synchronized irradiation with the authors' system allowed convenient and reliable reduction of the target volume. Further study is needed to standardize the system for clinical use.

Molecular weight of hyaluronate in the serum of patients with chronic liver disease

Hyaluronate in tissue and lymph is known to be heterogenous and to show a wide range of molecular weights (10(4) to 10(7) Da). Serum hyaluronate concentrations are increased under various pathophysiological conditions such as liver disease, post-gastrectomy, and after the ingestion of food. To clarify whether the chromatographic patterns of hyaluronate in serum from patients with chronic liver disease are different under these conditions, we subjected sera to chromatography using a Sephacryl S 400 HR column. The chromatograms revealed that the hyaluronate in serum was eluted as a single peak at the position corresponding to the molecular weight of blue dextran, the molecular weight being more than 2 x 10(6) Da. The patterns of the chromatogram were similar among the patients with liver disease and the healthy subject although the heights of the peaks were different. Ingestion of food and a history of gastrectomy for gastric cancer did not influence the elution patterns of serum hyaluronate. These results indicate that hyaluronate in serum has molecular weight of more than 2 x 10(6) Da, and that its elution patterns are not influenced by pathophysiological factors, such as the severity of liver disease, or history of gastrectomy or by food intake in patients with chronic liver disease.

Acute tubulointerstitial nephritis associated with piperacillin therapy in a boy with glomerulonephritis

An 11-year-old boy with glomerulonephritis developed acute renal failure 4 days after beginning piperacillin (PIPC) treatment. Renal biopsy revealed acute tubulointerstitial nephritis (ATIN) with marked eosinophils. A lymphocyte stimulation test (LST) for PIPC demonstrated an extremely high LST index of 626%. The serum levels of immunoglobulin E and eosinophil cationic protein also showed a significant increase at 9021 IU/mL and greater than 150 micrograms/L, respectively. These observations suggest that a hypersensitivity reaction might play a role in the pathogenesis of ATIN. This is the first report to describe PIPC-induced ATIN in a child.

[A case of an adult neuroblastoma with bone-marrow metastases: 131I-MIBG scintigraphy in comparison with MRI]

To detect a primary neuroblastoma lesion and its metastases, 131I-MIBG scintigraphy was performed for a 24-year-old woman who had a high level of serum catecholamine. 131I-MIBG scintigrams showed high radioactivity in the left upper quadrant, pelvic bone, and vertebral bodies. A biopsy of the pelvic bone revealed metastasis from the neuroblastoma. After four chemotherapy courses, the accumulation of 131I-MIBG decreased after each course; however, scintigraphy performed after the last chemotherapy course showed focal mild uptake in the right sacroiliac. The presence of residual tumor in the sacroiliac was confirmed histologically. On the other hand, T1-weighted and T2-weighted MR images performed before the treatment showed low signal intensity and high signal intensity in the pelvic bone, respectively. After the fourth chemotherapy course, T2-weighted MR images showed low signal intensity in the pelvic bone; however, it was difficult to determinate whether it should improve. To assess the effect of treatment of neuroblastoma, 131I-MIBG scintigraphy was considered more useful than MRI.

Extrahepatic portal obstruction without hepatopetal pathway associated with congenital arterioportal fistula: a case report

Extrahepatic portal obstruction is one of the causes of portal hypertension, in which well-developed hepatopetal pathways are commonly recognized. Herein an extremely rare case of extrahepatic portal obstruction without hepatopetal pathway, probably caused by arterioportal fistula, is reported. The patient was a normally matured 16-year-old girl admitted for further evaluation of jaundice, presenting with the clinical manifestations of the portal hypertension associated with hypersplenism and portosystemic venous shunt. Celiac angiography clearly demonstrated an intrahepatic arterial aneurysm fed by the right hepatic artery shunting to the superior mesenteric vein, and portography disclosed complete obstruction of the portal trunk with conspicuous hepatofugal pathway but no hepatopetal collateral veins. The exact mechanism of this phenomenon is not known and whether the extrahepatic portal obstruction was primary or secondary is still obscure. However, this is the first case report in the world literature describing extrahepatic portal obstruction with absence of hepatopetal pathway.

Neural network learning based on stochastic sensitivity analysis

A comprehensive theoretical framework is proposed for the learning of a class of gradient-type neural networks with an additive Gaussian white noise process. The study is based on stochastic sensitivity analysis techniques, and formal expressions are obtained for the stochastic learning laws in terms of the functional derivative sensitivity coefficients. The present method efficiently processes the learning information inherent in the stochastic correlation between the signal and corresponding noise processes without the need for actually computing equations of the back-propagation type. New stochastic implementations of the Hebbian and competitive learning laws are derived to elucidate this theoretical development.

[Effects of disease modifying antirheumatic drugs (DMARDs) and DEX on IL-1 beta and IL-6 production by IL-1 beta stimulated synovial culture cells]

To investigate the effects of disease modifying antirheumatic drugs (DMARDs) and DEX on production of IL-1 beta, IL-6 and TNF-alpha, synovial cells were observed after IL-1 beta administration in vitro.

MATERIALS AND METHODS

Synovial tissue was obtained aseptically from 8 rheumatoid arthritis patients during joint surgery. The dissected tissue was treated with collagenase and adherent cells were passaged before using as samples. They were stimulated with IL-1 beta (1 ng/ml) and cultured with DMARDs and DEX in serum-free media. After 24 hours' incubation, the production of IL-1 beta, IL-6 and TNF-alpha in the supernatants was measured.

RESULTS

DEX inhibited the production of IL-6. GST inhibited the production of IL-1 beta and IL-6.

CONCLUSION

DEX and GST may modulate the disease activity by inhibiting the cytokine production from synovial cells.

Clinical and histopathological studies in children with supraventricular tachycardia

To determine whether myocardial changes in patients with supraventricular tachycardia (SVT) are primary or secondary to persistent tachycardia, 11 patients with SVT were studied. These patients were divided into 2 groups with respect to the type of SVT. Group I consisted of 5 patients with incessant SVT and one with multifocal atrial tachycardia, while group II consisted of 4 patients with paroxysmal supraventricular tachycardia and one with short-run supraventricular premature contraction. All of the patients underwent electrophysiological study and endomyocardial biopsy from the right ventricle following routine cardiac catheterization. In group II, there were no significant abnormalities in the clinical and hemodynamic parameters. In group I, 3 patients had clinical features of dilated cardiomyopathy including abnormal ECG, chest X-ray and hypokinesis on left ventriculography. Induction and termination of SVT were possible in 2 patients in group I and in 4 of the 5 patients in group II. The only significant histologic difference between group I and group II was fibrosis. A high incidence of histopathological abnormalities, such as hypertrophy, degeneration, interstitial fibrosis and disarray was observed in both groups. The incidence of significant pathology was higher in group I than in group II. Almost all of the patients were given antiarrhythmic drugs. One patient underwent a successful surgical procedure and normal cardiac function returned after resection of the foci of the right atrium. Our present results suggest that patients with SVT who have incessant or recurrent SVT should undergo not only intracardiac electrophysiologic study but also endomyocardial biopsy for the evaluation of myocardial damage, since SVT might be the initial sign of cardiomyopathy.

Effects of canrenoate potassium, an aldosterone antagonist on portal hemodynamics in patients with compensated liver cirrhosis

BACKGROUND/AIMS

Long-term administration of spironolactone is reported to reduce portal pressure in cirrhotic patients. We examined the effects of acute administration of canrenoate potassium, an aldosterone antagonist, on portal hemodynamics in compensated cirrhotic patients using noninvasive duplex Doppler ultrasonography.

MATERIALS AND METHODS

Baseline values were obtained in the fasting state, and then 200mg of canrenoate potassium in 10ml of saline solution was intravenously administered to 22 patients, whereas 10ml of saline solution was administered as a placebo to 8 patients.

RESULTS

The portal cross-sectional area, portal blood velocity and portal blood flow decreased by 5.3 +/- 9.2, 10.4 +/- 8.7% and 13.0 +/- 12.4%, respectively at the nadir 60min after administration and these decreases persisted until 120min. Placebo did not affect these parameters of portal hemodynamics. Eleven responders, who had a more than 10% drop in portal blood flow 60min after administration, had significantly higher levels of plasma aldosterone than 8 non responders who had less than 10% drop. The reduction rate of portal blood flow was closely correlated with plasma aldosterone level.

CONCLUSIONS

These findings suggest that aldosterone antagonist directly causes a reduction in portal blood flow, probably through inhibition of aldosterone-induced vasoconstrictive action.

Serum markers for fibrosis and plasma transforming growth factor-beta 1 in patients with hepatocellular carcinoma in comparison with patients with liver cirrhosis

In order to elucidate collagen metabolism in hepatocellular carcinoma (HCC) tissue, we compared levels of different potential markers of collagen metabolism and plasma transforming growth factor-beta 1 in patients with HCC and in patients with liver cirrhosis. Serum levels of prolyl hydroxylase and the tissue inhibitor of metalloproteinase-1 in patients with HCC were significantly higher than those in patients with liver cirrhosis and increased with the size of the HCC tumour, whereas the serum levels of procollagen type III propeptide and type IV collagen 7S domain were similar in the two groups. In HCC, the increased plasma transforming growth factor-beta 1 levels were closely correlated with serum levels of prolyl hydroxylase and the tissue inhibitor of metalloproteinase-1. These findings suggest that, in HCC tissue, the intracellular biosynthesis of collagen is enhanced, whereas the secretion of procollagen is disturbed and the degradation of collagen is suppressed by the excess production of the tissue inhibitor of metalloproteinase-1. The results also suggest that plasma transforming growth factor-beta 1 plays an important role in the altered metabolism of collagen in HCC.

Clinical significance of serum hyaluronan in patients with chronic viral liver disease

In order to elucidate the clinical significance of serum hyaluronan in chronic viral hepatitis, serum hyaluronan concentrations were measured using a sandwich enzyme binding assay in 115 patients with chronic viral hepatitis. These findings were examined in relation to the results of laboratory liver tests, levels of serum markers for fibrosis and liver histological findings. Serum hyaluronan levels increased with the progress of liver disease, particularly in liver cirrhosis. There were no significant differences in serum hyaluronan levels among the cirrhotic patients according to Child's grade. Multivariate analysis showed that the significant independent predictors of serum hyaluronan were serum aspartate aminotransferase (P = 0.020), serum alanine aminotransferase (P = 0.008), serum cholinesterase (P < 0.001), particularly serum type IV collagen 7S domain (P < 0.0001), and the histological degree of liver fibrosis (P < 0.0001). These findings suggest that elevated serum hyaluronan levels are closely related to the severity of liver fibrosis. We assessed the predictive value of serum hyaluronan in differentiating cirrhosis from chronic hepatitis, constructing receiver operating curves; we found that serum hyaluronan was a better test for diagnosing cirrhosis than serum type IV collagen 7S domain and laboratory liver tests.

Comparison of serum 7S fragment of type IV collagen and serum central triple-helix of type IV collagen for assessment of liver fibrosis in patients with chronic viral liver disease

BACKGROUND/AIMS

A competitive radioimmunoassay for serum 7S fragment of type IV collagen (7S collagen) using a polyclonal antibody against 7S collagen and a sandwich enzyme immunoassay for serum central triple-helix of type IV collagen (IV collagen) using two monoclonal antibodies against the pepsin-solubilized type IV collagen may be used as diagnostic aids for liver fibrosis in clinical medicine. We compared the clinical usefulness for assessing liver fibrosis of serum 7S collagen and IV collagen tests in chronic viral liver diseases, and also examined the elution pattern of 7S collagen- and IV collagen-related antigens in serum by gel filtration analysis.

METHODS

Serum 7S collagen and IV collagen levels were assayed in 151 patients with chronic viral liver disease and 30 healthy control subjects.

RESULTS

Gel filtration on the Sephacryl S400HR column revealed that the 7S collagen antigenicity in serum was heterogeneous, whereas the IV collagen antigen in serum was uniform in size. Serum levels of 7S collagen and IV collagen showed increases closely correlated with the severity of liver disease. The abnormal percentage of 7S collagen in three patient groups was similar to that of IV collagen in the corresponding groups. Serum 7S collagen and IV collagen levels were strongly correlated with the histological degree of liver fibrosis; the correlation coefficients were r = +0.675 for 7S collagen and r = +0.665 for IV collagen. When we assessed the ability of each test to detect cirrhosis with a receiver operating curve, the serum 7S collagen test was a slightly better marker than the serum IV collagen test. For the detection of cirrhosis, serum 7S collagen was 83% sensitive and 88% specific at a cutoff value of 9 ng/ml, and serum IV collagen was 80% sensitive and 81% specific at a cutoff value of 160 ng/ml.

CONCLUSIONS

These findings suggested that serum 7S collagen and IV collagen tests are similarly useful for assessing liver fibrosis in patients with chronic viral liver disease, although the former is slightly better for diagnosing cirrhosis than the latter.

Portal blood velocity and portal blood flow in patients with chronic viral hepatitis: relation to histological liver fibrosis

BACKGROUND/AIMS

This study represents an attempt to correlate portal hemodynamics in patients with chronic hepatitis.

MATERIALS AND METHODS

Portal blood velocity and portal blood flow were determined using the duplex Doppler system in 47 patients with chronic viral hepatitis, and findings were compared with the hepatic histological features.

RESULTS

Portal blood velocity decreased with the progress of chronic hepatitis, and closely correlated with the histological degree of liver fibrosis (p < 0.0001). The portal blood velocity in patients who had severe bridging fibrosis was significantly lower than that in the patients who had mild bridging fibrosis. However, the portal blood flow in patients with chronic persistent hepatitis and chronic active hepatitis was comparable with that in the controls, and did not correlated with liver histological findings.

CONCLUSIONS

These findings suggest that the portal blood velocity is a more sensitive indicator for assessing portal hemodynamics than portal blood flow in chronic viral hepatitis, and may be a useful test for differentiating chronic hepatitis with severe fibrosis from chronic hepatitis with mild fibrosis.

Serum markers for connective tissue turnover in patients with chronic hepatitis B and chronic hepatitis C: a comparative analysis

BACKGROUND/AIMS

Clinical and pathological differences between chronic hepatitis B and chronic hepatitis C have now been established.

METHODS

To compare hepatic connective tissue metabolism in chronic hepatitis B and C, we determined serum levels of prolyl 4-hydroxylase beta-subunit, procollagen III aminoterminal peptide, type IV collagen 7S domain, the central helix region of type IV collagen, tissue inhibitor of metalloproteinase, and hyaluronan in 55 patients with chronic hepatitis B and 83 patients with chronic hepatitis C.

RESULTS

There were no significant differences in the above markers for connective tissue turnover between the chronic hepatitis B group and the chronic hepatitis C group.

CONCLUSIONS

These results suggest that the accelerated connective tissue metabolism observed in chronic viral hepatitis is independent of the causative virus.

Effects of bathing in hot water on portal hemodynamics in healthy subjects and in patients with compensated liver cirrhosis

Bathing in hot water induces vasodilatation of the peripheral vessels and alteration of blood distribution. Using a Doppler flowmeter, we evaluated the effect of bathing in hot water on portal hemodynamics. Eight controls and 8 patients with compensated liver cirrhosis remained immersed in hot water at 42 degrees C for 5 minutes. Portal flow significantly decreased from 811 +/- 141 (ml/min) at the baseline to 530 +/- 98 in the controls and from 855 +/- 308 to 642 +/- 208 in cirrhotics immediately after bathing. This decrease (25%) in cirrhotics was significantly less than that (35%) in controls because vessel diameter did not decrease as rapidly as it did in controls. Portal flow after 30 minutes returned to the baseline values in controls but remained low in cirrhotics. These findings suggest that cirrhotics have a lower hemodynamic response to bathing in hot water compared with that in controls.

Asymptomatic extrahepatic portal obstruction without portal hypertensive findings detected in ultrasonic mass screening

BACKGROUND/AIMS

We report three adult cases of extrahepatic portal obstruction (EHPO) detected by ultrasonic (US) mass screening.

MATERIAL AND METHODS

All these cases were asymptomatic with no abnormalities on hematological or biochemical tests. Only indocynanine green clearance test revealed a slight abnormality. By imaging modalities, the portal trunk could not be visualized and cavernous transformation could be visualized.

RESULTS

There were no findings of portal hypertension, such as splenomegaly, esophageal varices and hepatofugal collaterals, in any of these cases.

CONCLUSIONS

As many EHPOs without symptoms can be detected on US mass survey, US is considered to be the best modality for screening for this disease.

Selective induction of IgM rheumatoid factors by CD14+ monocyte-lineage cells generated from bone marrow of patients with rheumatoid arthritis

OBJECTIVE

To determine the capacity of CD14+ monocyte-lineage cells induced from bone marrow of rheumatoid arthritis (RA) patients to stimulate the production of IgM rheumatoid factor (IgM-RF), in order to explore the functional abnormalities of CD14+ cells and gain insight into the mechanism of selective synthesis of IgM-RF in RA.

METHODS

CD14+ cells were induced by granulocyte-macrophage colony-stimulating factor (GM-CSF) stimulation of CD14- cells purified from bone marrow cells obtained from 6 RA patients and 6 osteoarthritis (OA) patients. The production of IgM and IgM-RF was induced by stimulating B cells from normal healthy individuals with immobilized anti-CD3-activated autologous CD4+ T cells. The effects of CD14+ cells on the proportion of IgM-RF to total IgM produced by the normal B cells were assessed.

RESULTS

CD14+ cells induced by GM-CSF stimulation of bone marrow CD14- cells from the 6 RA patients significantly enhanced the proportion of IgM-RF to total IgM produced by anti-CD3-activated CD4+ T cell-stimulated normal B cells (P < 0.05), whereas GM-CSF-induced CD14+ cells from the bone marrow of the 6 OA patients did not significantly affect IgM-RF production. CD14+ cells induced by GM-CSF obtained from different sites in the same RA patient on different occasions consistently enhanced the proportion of IgM-RF to IgM produced by B cells from different normal subjects.

CONCLUSION

These results indicate that abnormal CD14+ monocytes stimulate RF-producing B cells to be ready to be activated by the signals delivered through noncognate T-B interactions with anti-CD3-activated T helper cells. Moreover, the data suggest that the accelerated generation of such functionally abnormal CD14+ cells from bone marrow precursors might play an important role in the pathogenesis of RA.

The relationship between the hair cycle and the age or daily body weight gain in rabbits

The relationship between the hair cycle and the age or daily body weight gain (daily gain) in rabbits was investigated. A survey of the ages of rabbits used for the dermal toxicological studies in our laboratories over the last 4 years was done, followed by an experiment to confirm the results of the survey. Although there seemed to be no relationship between the hair cycle and the daily gain, the results showed that the hair cycle was closely related to the age of the animal, and the animals in the telogen stage may be obtained efficiently at about 17 wks of age.

Serum type III procollagen peptide, type IV collagen 7S domain, central triple-helix of type IV collagen and tissue inhibitor of metalloproteinases in patients with chronic viral liver disease: relationship to liver histology

To assess the clinical value of serum biochemical markers, the aminoterminal peptide of type III procollagen, type IV collagen 7S domain, the central triple-helix of type IV collagen and tissue inhibitor of metalloproteinases, as a marker of hepatic fibrosis, we measured these four serum markers in 132 patients with chronic viral liver disease and compared these serum markers with liver histological findings. Serum levels of these markers increased closely with the progress of liver disease, and the abnormal percentages of type III procollagen peptide, type IV collagen 7S domain, central triple-helix of type IV collagen and tissue inhibitor of metalloproteinases in patients with cirrhosis were 97%, 95%, 83% and 48%, respectively. These four serum markers strongly correlated with the histological degree of periportal with or without bridging hepatocellular necrosis and of liver fibrosis and correlated weakly with the degree of intralobular degeneration and focal necrosis and the degree of portal inflammation. The correlation coefficients of serum type IV collagen 7S domain with periportal with or without bridging hepatocellular necrosis and with liver fibrosis were the highest among these four serum markers, suggesting that serum type IV collagen 7S domain is the most valuable diagnostic marker to assess the degree of liver fibrosis in chronic viral liver disease. When we assessed the ability of each serum marker to detect cirrhosis with a receiver operating curve, the best test was type IV collagen 7S domain, and the second best was type III procollagen peptide.(ABSTRACT TRUNCATED AT 250 WORDS)