Proton magnetic resonance identification and discrimination of stereoisomers of C27 steroids using lanthanide shift reagents

A simple proton magnetic resonance spectroscopic method is described for the identification and and confirmation of several stereoisomeric paris of C27 stanols as well as their keto and acetate derivatives related to cholesterol. The method, which involves the use of lanthanide shift reagents, is useful in distinguishing clearly between the isomeric pairs differing only in the geometry of a functional group and/or of the A/B-ring junction in the steroid skeleton.

[Study of conservative treatment of breast cancer in view of the spread of primary lesion]

Two hundred and six patients with breast cancer t1 or t2 were subclassified histologically into the following 8 types; comedo type, papillary type, mucous type, papillotubular or cribriform type, small solid alveolar type, large solid alveolar type, sclerotic type and pure scirrhous type. The risk of remaining cancer with lumpectomy was investigated clinicopathologically in relation to intraductal spread and lymphatic invasion of cancer cells. The tumor invasion was classified into intraductal type, localized type or extraductal spreading type, and lymphatic invasion was divided into 2 grades, i.e., vicinity of the tumor and 5mm or more distant. 1. In cases of intraductal spread, the comedo type was the most frequent, followed by the papillary type and mucous type. 2. The small solid alveolar type accounted for the highest proportion, 22.7%, in the group with distant lymphatic invasion. 3. The incidence of lymph node metastasis was as high as 63.6% and 61.7% for the small solid alveolar type and pure scirrhous type. 4. In cases of intraductal spread, t1 accounted for 32.6% and t2 for 47.0%. 5. The incidence of positive lymph node metastasis was 28.9% for t1 and 52.0% for t2. Tumors associated with a higher risk of remaining cancer are those of the comedo type and papillary type in terms of intraductal spread, those of the small solid alveolar type and pure scirrhous type in terms of lymphatic invasion, and those measuring 2cm or more.

Alpha-form of atrial natriuretic peptide released from dog atrium during atrial distension

To assess the released form of atrial natriuretic peptide (ANP) during atrial distension, we compared the form of ANP before and during atrial distension in anesthetized dogs, using radioimmunoassay combined with high performance liquid chromatography (HPLC). When increasing the left atrial pressure (LAP) from 2.2 +/- 0.9 mmHg to 9.4 +/- 1.3 mmHg, the plasma ANP concentration in the coronary sinus was increased by 190% over the control, during left atrial distension. The major form of the released ANP extracted in the blood sample obtained from the coronary sinus was alpha-form. However other unidentified immunoreactive peaks, preceding and following the main peak were also discernible. These results suggest that the major form of ANP released during left atrial distension was the alpha-form.

[Choroidal vascular lesions in serous retinal detachment viewed with indocyanine green angiography]

In serous retinal detachment due to damaged retinal pigment epithelium (RPE), fluorescein angiography shows dye leakage into the subretinal space from the choroid. We performed indocyanine green (ICG) angiography in 110 eyes with serous retinal detachment comprising 71 eyes with central serous chorioretinopathy (CSC), 19 with bullous retinal detachment, 18 with Harada's disease, and 2 with toxemia of pregnancy. Choroidal tissue staining was present around the site of subretinal leakage in late-phase ICG angiograms from 63 eyes with CSC and 18 with bullous retinal detachment. ICG angiography also showed leakage from choroidal vessels in 16 eyes with Harada's disease and 2 with toxemia of pregnancy. As a common feature, ICG angiography showed choroidal vascular hyperpermeability in various types of serous retinal detachment. Choroidal circulation was delayed in Harada's disease and toxemia of pregnancy. Choroidal hypoperfusion and hyperpermeability of choroidal vessels probably contribute to the damage of RPE, and choroidal vascular hyperpermeability probably provides fluid pressure to move fluid into the subretinal space from the choroid.

Examination about more realistic prognosis evaluation method, how long the patients with congestive heart failure can spend at home

Background

From August 2015, for efficient medical care in congestive heart failure (CHF) cases, we had introduced a unique clinical pathway (PATH) provided the immediate use of Tolvaptan and comprehensive education by multi-disciplinary staff after admission. And by introduction of PATH, we confirmed the shortening effect of hospitalization period with CHF and the suppressive effect of readmission with CHF after discharge. But since almost CHF patients repeat hospitalization and discharge due to change of their medical condition, the investigation for only first readmission rate after discharge is not enough to assess the entire long clinical course of CHF. Recently we found one report about evaluation method for CHF clinical prognosis, how long CHF patients can stay healthy at their own home after discharge within a certain period. This evaluation method is considered to take into account the long clinical course of CHF.

Purpose

We investigated whether the CHF patients introduced PATH on admission could stay longer at their home than CHF patients without PATH.

Methods

Between April 2014 and July 2019, 471 CHF cases, who ware admitted in our hospital at first and could be followed up for at least 1 month after discharge, ware enrolled. We divided them to two groups, PATH- group before introducing PATH (until July 2015, 142 cases), and PATH+ group applied PATH (after August 2015, 329 cases). Between both groups, we investigated the readmission rate (RR) with CHF and the total period (TP) that patients could spend at home within1, 3, 6 and 12month after discharge.

Results

There were no significant differences in mean age, pre-hospital living status, or clinical status at admission between the two groups. On the other hand, due to efficient CHF care, the average length of hospital stay was significantly shorter (figure1). RR within 1, 3, 6 and 12 months after discharge ware all lower in PATH+ group. And TP within 1, 3, 6 and 12 months after discharge ware all longer in PATH+ group (figure2).

Conclusion

By introducing our unique clinical pathway for congestive heart failure cases requiring hospitalization, we could confirm not only the improvement of their conventional clinical prognosis index but also the improvement of their new and more realistic clinical prognosis index after discharge.

Funding Acknowledgement

Type of funding sources: None. Figure 1Figure 2

Tibial nerve entrapment at the tendinous arch of the soleus: a case report

Tibial nerve entrapment at the tendinous arch of the soleus has not been reported. A 58-year-old woman suffered from pain in the sole of her left foot, which was aggravated by active plantar flexion or passive extension of the ankle. Computed tomography and magnetic resonance imaging revealed a hypertrophic lesion in the left popliteus muscle. The tibial nerve was pushed posteriorly by the lesion and compressed by the arch of the soleus. The arch of the soleus was divided surgically. Pain was resolved immediately after the surgery, and significant neurologic recovery was observed 1 year after the surgical treatment. This condition must be recognized as a different clinical entity than either lumbar radiculopathy or tarsal tunnel syndrome.

Idiopathic portal hypertension and lower limb lymphedema

Idiopathic lymphedema is a condition where lymph accumulates in subcutaneous tissue without a clear cause. Likewise, idiopathic portal hypertension is a syndrome where intrahepatic peripheral portal branch obstruction causes portal hypertension without a clear cause. We encountered a 37-year-old man with both idiopathic lymphedema and idiopathic portal hypertension. He had a history of right lower limb edema and epigastric varices since childhood with repeated cellulitis in the affected limb. Lymph accumulation and dilation of collateral lymph pathways in the right lower limb were observed by indocyanine green and lymphoscintigraphy, and a serpentine thoracic duct was observed using MRI. Idiopathic portal hypertension and idiopathic lymphedema were diagnosed, and peripheral lymphaticovenous anastomosis was performed for treatment of lymphedema. The limb circumference improved, and the frequency of cellulitis decreased. It is postulated that an abnormality in the embryonic cardinal vein before lymph vessel differentiation could be a possible mechanism of the dual pathologic conditions.