FDG PET in the evaluation of the aggressiveness of pulmonary adenocarcinoma: correlation with histopathological features

2-[Fluorine-18]fluoro-2-deoxy-d-glucose (FDG) uptake within the primary lesion correlates with survival on positron emission tomography (PET) studies of patients with non-small cell lung cancer. The more metabolically active the tumour, the worse the outcome. The aim of this study was to determine whether a correlation exists between aggressiveness as determined by pathology and the findings of FDG PET in pulmonary adenocarcinoma. Thirty-five patients with 38 adenocarcinomas of the lung were studied. All patients underwent thoracotomy within 4 weeks of the FDG PET study. For semiquantitative analysis, standardized uptake values (SUVs) were calculated. Patients were classified into high SUV (> or = 4.0) and low SUV (<4.0) groups. The degree of FDG uptake (SUVs) in primary lung lesions was correlated with the histopathological features of aggressiveness (pleural involvement, vascular invasion or lymphatic permeation). The mean SUV of aggressive adenocarcinomas (4.36+/-1.94, n = 22) was higher than that of non-aggressive ones (1.53+/-0.88, n = 16) (P < 0.0001). Tumours with a high FDG uptake have a significantly higher likelihood of aggressiveness than those with a low FDG uptake (P = 0.0004). Analysis by the Kaplan-Meier methods revealed that the groups had different prognoses (log-rank test, P = 0.0099). The high SUV group had a significantly worse prognosis. In conclusion, a correlation was seen between aggressiveness as determined by pathology and glucose metabolism as measured by FDG PET in adenocarcinoma of the lung. FDG PET may be used as a non-invasive diagnostic technique in measuring aggressiveness and prognosis in patients with pulmonary adenocarcinoma.

Ecological adaptation and acclimatization of natural freshwater phytoplankters with a nutrient gradient

Ecological adaptation and acclimatization of natural phytoplankters within a nutrient gradient were studied in an oligotrophic pond with special reference to the diel fluctuations of cell volumes and frequency of dividing cells (FDC) at each season using an in situ gradostat. The predominant phytoplankters (Cryptomonas ovata in spring and autumn, Crucigenia rectangularis in summer and Chlamydomonas elongus in winter) exhibited moderately phased division during each season. These diel cycles could be regressed onto a sine curve to give a highly significant fit. The diel patterns in all gradostat chambers and periods were almost the same except for slight variations in the FDC. This shows that the diel pattern of cell division was governed mainly by the light:dark cycle during the 24 h, without regard to trophic differences of the aquatic environment. The mean growth rates of most phytoplankters were higher in the mesotrophic zone than in the eutrophic zone during each season. In winter, the growth rate of Chlamydomonas elongus was evidently greater during the seventh day of the experiment (Period III) than during the first day (Period I) in the mesotrophic chamber. As Chlamydomonas species occur as mesotrophic species in natural waters, Chlamydomonas elongus must acclimatize easily from the oligotrophic habitat to the mesotrophic environmental condition.

Gram stain index of a natural bacterial community at a nutrient gradient in the freshwater environment

Species succession of a natural bacterial community was indicated by the Gram stain index (GSI) using an experimental nutrient gradient in an oligotrophic pond created with an in situ gradostat. Various trophic conditions, ranging from eutrophic to mesotrophic, were formed experimentally with continuous inflow of sterile peptone solution in the gradostat, while the water mass outside the gradostat was oligotrophic. The GSI spectra of the natural bacterial populations show different profiles in accordance with the trophic level of the ambient water and the time progression of adaptation to different levels of eutrophication. Therefore, GSI can be used as a potential indicator of organic pollution in aquatic environments.

Acylated delphinidin 3-rutinoside-5-glucosides in the flowers of Petunia reitzii

Two acylated anthocyanins were isolated from selected individuals of Petunia reitzii, and identified to be delphinidin 3-O-[6-O-(4-O-(4-O-(6-O-(trans-caffeoyl)-beta-D-glucopyranosyl)-tr ans-p-coumaroyl)-alpha-L-rhamnopyranosyl)-beta-D-glucopyranoside]- 5-O-[beta-D-glucopyranoside] and delphinidin 3-O-[6-O-(4-O-(4-O-(beta-D-glucopyranosyl)-trans-p-coumaroyl)-alph a-L-rhamnopyranosyl)-beta-D-glucopyranoside]-5-O-[beta-D-glucopyranoside ]. Nine known anthocyanins were also identified.

Value of dynamic MR imaging in assessing endometrial carcinoma involvement of the cervix

OBJECTIVE

The purpose of this study was to evaluate endometrial carcinoma involvement of the cervix using dynamic MR imaging compared with T2-weighted and contrast-enhanced T1-weighted MR imaging.

SUBJECTS AND METHODS

In 42 patients with endometrial carcinoma, T2-weighted MR imaging using rapid acquisition with relaxation enhancement, dynamic MR imaging using gradient-echo sequences, and contrast-enhanced T1-weighted MR imaging using spin-echo sequences were performed before treatment. We evaluated patterns of enhancement in the cervix and tumor. In 39 of the 42 patients who underwent surgical treatment, we compared MR imaging findings with histologic results concerning cervical involvement.

RESULTS

Enhancement of the cervical epithelium was greater than that of the tumor and cervical stroma on dynamic MR imaging in most patients. In assessing cervical involvement, the accuracy of T2-weighted, dynamic, and contrast-enhanced T1-weighted MR imaging was 85%, 95%, and 90%, respectively; no statistically significant difference was observed. False-positive cases on T2-weighted MR imaging were correctly identified as having no cervical involvement on dynamic MR imaging using the finding of continuous enhancement of the cervical epithelium. We found this finding to be reliable in assessing tumor involvement of the cervix.

CONCLUSION

We believe that, in combination with T2-weighted MR imaging sequences, dynamic MR imaging is useful in assessing endometrial carcinoma involvement of the cervix.

The effects of the traditional chinese medicine, "Banxia Houpo Tang (Hange-Koboku To)" on the swallowing reflex in Parkinson's disease

Swallowing disorder is common in Parkinson's disease (PD). We studied the swallowing disorder in PD, and tested the efficacy of Banxia Houpo Tang (BHT, a Chinese traditional medicine) in improving the swallowing reflex of PD patients. The Swallowing reflex test is a simple method used to detect swallowing disorders in patients with cerebrovascular disease. Because we observed previously that BHT significantly improved the swallowing reflex in cerebrovascular patients, we studied whether BHT was also effective in improving the swallowing disorder in patients with PD. 23 PD patients (13 males, 10 females, mean age 66.0+/-9.3, Hoehn & Yahr (H-Y) mean score = 2.8) were evaluated for swallowing reflex and the concentration of substance-P in their saliva before and after 4 weeks of BHT treatment. The swallowing reflex before treatment was significantly delayed, according to the H-Y score (Spearman's p = 0.014, R2 = 0.463). The swallowing reflex before BHT treatment was 3.66+/-0.98 sec, and after BHT treatment, it improved significantly, to 2.27+/-0.54 sec (p < 0.0001). Substance-P concentration in PD patients saliva before treatment was significantly lower than in healthy controls (p = 0.007), but showed no significant change after BHT treatment. Our research shows that the swallowing reflex is an effective method to evaluate the swallowing disorder in PD. BHT can significantly improved the swallowing reflex in PD patients, and therefore can be a hopeful candidate for preventing aspiration pneumonia in PD.

Long-term result of arterial grafts interposed for arterial defects using the telescoping anastomotic technique: histological and angiographic study

The arterial grafting model for arterial defects provides an ideal environment for the microvascular telescoping anastomosis because tension of the repaired vessel is maintained low and deformities of the inserted vessel end is minimal due to the thick arterial wall. The left femoral artery was grafted in 46 rats into the defect created in the right femoral artery using the telescoping anastomotic technique at both the proximal and distal anastomoses. The grafts were seen histologically and angiographically 3 to 4 months postoperatively in order to fairly evaluate the telescoping anastomosis in terms of long-term patency, stenosis, and changes in the outer and inner walls at the anastomosis. All arterial grafts were patent 3 to 4 months postoperatively and there were no aneurysms at the anastomoses. Enlargement of the graft diameter was minimal. The rate of stenosis at the anastomosis was smaller than that 1-day postoperatively. Even though the thick arterial wall was initially inserted and the intimal hyperplasia was still present at the anastomosis 3 to 4 months postoperatively, the long-term stenosis was relatively mild due to the atrophy in the overlapped walls.

Differences in the floral anthocyanin content of red petunias and Petunia exserta

In order to resolve a conflict between previous papers regarding the floral anthocyanins of red flowers of Petunia exserta, a naturally occurring species, the HPLC profile of this species was compared with that of commercial red garden petunias. Both HPLC profiles extremely superficially resemble each other in terms of relative amounts and retention times of the major anthocyanins. However, co-elution on HPLC of the mixed sample resulted in clear separation of the components. Three major anthocyanins in red petunias were determined to be cyanidin 3-sophoroside, cyanidin 3-glucoside and peonidin 3-glucoside, which exhibited similar behaviors on HPLC to delphinidin 3-glucoside. delphinidin-3-rutinoside and petunidin 3-rutinoside, respectively, the major floral anthocyanins of P. exserta.

Tubular injury as a cardinal pathologic feature in human heme oxygenase-1 deficiency

Heme oxygenase (HO) catalyzes degradation of heme to biliverdin, iron, and carbon monoxide. It consists of three isoforms: an inducible form (HO-1), a constitutive form (HO-2), and the third isoform (HO-3), with properties similar to HO-2. There is limited evidence to suggest that the induction of HO-1 may have anti-inflammatory effects in an in vivo model of oxidative stress-mediated renal injury. We experienced the first human case of HO-1 deficiency. The patient had persistent proteinuria and hematuria, with biochemical evidence of renal tubular injury. We obtained three consecutive renal specimens: two from renal biopsies at 2 and 5 years of age and the third from autopsy at 6 years of age. The patient had systemic vascular endothelial-cell injury with massive intravascular hemolysis. The serum was loaded with heme and a large amount of heme-conjugated haptoglobin. A high concentration of haptoglobin was also detectable in urine. Mesangial proliferation or change in glomerular capillary-wall thickness was relatively mild to moderate in all specimens. Electron microscopic examination showed widespread endothelial detachment and subendothelial deposits of an unidentifiable material. It was striking that tubulointerstitial injury, with tubular dilatation and/or atrophy, interstitial fibrosis, and inflammatory cell infiltration, advanced progressively. Tubular epithelial cells were injured, and massive deposition of iron and haptoglobin was detectable. Bowman's capsules were dilated significantly, probably secondary to the collapse of atrophic tubuli. This is the first report to show that HO-1 has critical roles in vivo in protecting renal tubuli, in addition to vascular endothelium, from oxidative injury.

Adsorption of Water-Soluble Proteins onto Bubbles in Continuous Foam Separation

The mechanism of water-soluble protein enrichment in continuous foam separation was studied. The liquid flow rate and the protein concentration in the foam phase were measured at various heights from the interface between the bulk liquid and foam layer, and the intrinsic values at the interface were estimated by the extrapolation method to determine the accurate adsorption density on the bubble surface. Ovalbumin (OA) and hemoglobin (HB) were used as the soluble proteins. The solution pH values were varied from 3.5 to 6.0 for OA and from 6.0 to 8.0 for HB. The experimental isotherms for OA and HB were compared to the Langmuir isotherm, and the two adsorption parameters of the equilibrium constant, K, and the saturated density, gamma, at each pH were determined. Both gamma values obtained for OA and HB showed maxima at their isoelectric point (pH 4.6 for OA and pH 6.8 for HB). Assuming that OA and HB molecules are spherical in shape and are adsorbed on the bubble surface in a close-packed structure at saturation, the calculated diameters for OA and HB molecules were quite similar to the literature values. The variation in gamma for both OA and HB is discussed qualitatively in relation to the net charge of the protein molecule. Copyright 2000 Academic Press.

Diminished expression of CD59 on activated CD8+ T cells undergoing apoptosis in systemic lupus erythematosus and Sjögren's syndrome

The present study was undertaken to examine the phenotype of T cells undergoing in vitro apoptosis in patients with autoimmune diseases such as systemic lupus erythematosus (SLE) and primary Sjögren's syndrome (SS). Compared with normal controls, we found diminished expression of CD59 antigen (one of the cell-surface complement-regulatory proteins) on CD8+ T cells, but not on CD4+ T cells, from patients with SLE and SS. Three-colour immunofluorescence analysis revealed that these CD59dim CD8+ T cells were activated T cells, expressing both human leucocyte antigen (HLA)-DR and CD45RO antigens. In addition, these CD59dim CD8+ T cells were more susceptible to in vitro apoptosis than CD59bright CD8+ T cells. In two patients with active lupus, the percentage of CD59dim CD8+ T cells was significantly decreased after steroid therapy. These findings suggest that decreased expression of CD59 antigen on in vivo-activated CD8+ T cells may be correlated with disease activity and may be involved in activation-induced apoptosis in patients with SLE and SS.

Identification of deoxymiroestrol as the actual rejuvenating principle of "Kwao Keur", Pueraria mirifica. The known miroestrol may be an artifact

Miroestrol (1) has been isolated previously as an active principle from "Kwao Keur" (Pueraria mirifica), a rejuvenating folk medicine from Thailand. Reinvestigation using bioassay-guided purification has resulted in the isolation of a new potent phytoestrogen, deoxymiroestrol (2). The facile aerial oxidation of 2 into 1 suggests the possibility that 1 may be an artifact.

FDG PET measurement of the proliferative potential of non-small cell lung cancer

The goals of this study were to correlate FDG uptake with cell proliferation and cellular density in non-small cell lung cancer.

METHODS

Thirty-one patients with 32 non-small cell lung cancers were examined with FDG PET. For semiquantitative analysis, standardized uptake values (SUVs) were calculated. All patients underwent thoracotomy within 4 wk after the FDG PET study. Cell proliferation was immunohistochemically assessed as the relative number of cells expressing the proliferating cell nuclear antigen ([PCNA] labeling index). Cellular density was also evaluated using light microscopy.

RESULTS

SUVs correlated significantly with PCNA labeling index (r = 0.740; P < 0.0001) but only weakly with cellular density (r = 0.392; P = 0.0266). High FDG uptake correlated with high PCNA expression. The PCNA labeling index and SUVs were significantly lower in bronchioloalveolar carcinomas (n = 8) (12.3 +/- 9.45% and 1.45 +/- 0.76, respectively) than in nonbronchioloalveolar carcinomas (n = 19) (33.5 +/- 21.8%, P = 0.015, and 3.75 +/- 1.93, P = 0.003, respectively). However, no significant differences in cellular density were seen between bronchioloalveolar carcinomas and nonbronchioloalveolar carcinomas.

CONCLUSION

FDG uptake is related to cell proliferation rather than to the cellular density of non-small cell lung cancer.

Tardy ulnar tunnel syndrome caused by Galeazzi fracture-dislocation: a neuropathy with a new pathomechanism

We present a case of late-onset ulnar tunnel syndrome following a Colles fracture. The nerve palsy was caused by a vascular branch that stretched over the ulnar head, compressing the nerve and generating friction against the ulnar head when the forearm was rotated. This is the first report of such a pathomechanism.

Characterization of immune function and analysis of RAG gene mutations in Omenn syndrome and related disorders

Omenn syndrome was recently found to be caused by missense mutations in RAG1 or RAG2 gene that result in partial V(D)J recombination activity. Although the clinical hallmarks of the disease are well defined, there have been several cases with clinical findings similar to, but distinct from Omenn syndrome. The data on immune functions and RAG gene mutations of such cases are limited. We described five Japanese infants from four unrelated families, including two cases of Omenn syndrome and three cases of related disorders. Sibling cases with typical Omenn phenotype were found to be compound heterozygotes of R396C and L885R mutations in RAG1. The former has been reported in European cases and may constitute a hot spot. The latter is a novel missense mutation. Infants with related disorders exhibited erythroderma, eosinophilia, hypogammaglobulinaemia, decreased number of B cells and skewing to Th2, and their lymph node specimens showed architectural effacement, lymphocyte depletion and histiocytic hyperplasia, each of which is seen characteristically in Omenn syndrome. However, in these cases serum IgE levels were low or undetectable. We found no mutation in RAG genes except for a K820R substitution in RAG1, which was regarded to be a functional polymorphism, in two of these cases. Our study suggests that RAG missense mutation may be a genetic abnormality unique to Omenn syndrome with characteristic clinical and laboratory findings. Variations of Omenn syndrome, or related disorders, may represent a different type of immunodeficiency, distinct from abnormalities in lymphoid-specific recombinase activity.

Pharmacokinetics of NS-105, a novel cognition enhancer. 2nd communication: distribution and transfer into fetus and milk after single administration, and effects of repeated administration on pharmacokinetics and hepatic drug-metabolizing enzyme activities in rats

The tissue distribution and transfer into the fetus and milk of NS-105 ((+)-5-oxo-D-prolinepiperidinamide monohydrate, CAS 110958-19-5), a novel cognition enhancer, were investigated in rats after single oral administration of 14C-NS-105. The effects of repeated oral administration on the pharmacokinetics of NS-105 and hepatic drug-metabolizing enzyme activities also were investigated in rats. The radioactivity concentration in most tissues of male rats reached a maximum of 0.5 h after the single oral administration of 14C-NS-105, indicating rapid absorption and distribution, 0.5 h after the administration, the highest concentrations were present in the kidney and stomach, and the lowest in the white fat. The concentrations in the remaining tissues were moderately lower than the plasma value. The radioactivity concentrations in all the tissues tested decreased along with the plasma concentration, and were below or near the detection limit 24 h after the administration. Most of the radioactivity in the plasma, liver, kidney and cerebrum was due to unchanged NS-105. The tissue distribution patterns of radioactivity in female (non-pregnant) and pregnant rats after the oral administration of 14C-NS-105 did not differ from the pattern in male rats, revealing neither sex- nor pregnancy-related differences in NS-105 distribution. In pregnant rats, the maximum concentration in the fetus was 66% of that in the maternal plasma. In lactating rats, the radioactivity concentration in the milk was similar to that in the plasma. During and after the repeated oral administration of 14C-NS-105, the plasma concentrations and cumulative urinary and fecal excretions of radioactivity did not change with the number of administrations and were similar to the corresponding values after the single administration. The radioactivity concentrations in most tissues 8 h after the 7th, 14th and 21st administrations were about twice the corresponding values after the single administration, indicating that there is no marked accumulation of radioactivity in the tissues and that a steady state level was reached within 1 week. Repeated oral administration of NS-105 (10 mg/kg) to male rats did not affect hepatic drug-metabolizing enzyme activities.

Suppressed severity of collagen-induced arthritis by in vivo transfection of nuclear factor kappaB decoy oligodeoxynucleotides as a gene therapy

OBJECTIVE

In both rheumatoid arthritis and collagen-induced arthritis (CIA), the nuclear factor kappaB (NF-kappaB) transcription factor plays a pivotal role in the coordinated transactivation of many cytokines related to pathogenesis. This study investigated whether synthetic double-stranded DNA that show a high affinity for NF-kappaB could be introduced in vivo as "decoy" cis elements to bind the transcription factor and block the activation of such proinflammatory cytokine genes as interleukin-1 (IL-1) and tumor necrosis factor alpha (TNFalpha), and thus suppress the severity of joint destruction.

METHODS

NF-kappaB decoy oligonucleotides (ODN) were introduced by an intraarticular injection into the bilateral hind ankle joints of CIA rats using the hemagglutinating virus of Japan (HVJ)-liposome method. Joint destruction was evaluated by histology and radiography. IL-1 and TNFalpha levels were assessed by enzyme-linked immunosorbent assay and Northern blot analysis.

RESULTS

Using the HVJ-liposome method, the presence of fluorescein isothiocyanate-labeled ODN in the synovium was confirmed until 28 days after intraarticular injection. In vivo transfection of NF-kappaB decoy ODN by an intraarticular injection into CIA rats decreased the severity of hind-paw swelling. Histologic and radiographic studies showed a marked suppression of joint destruction treated by NF-kappaB decoy ODN transfection. This treatment method also suppressed the production of IL-1 and TNFalpha in the synovium of arthritic joints.

CONCLUSION

The present results demonstrate that administration of NF-kappaB decoy ODN in arthritic joints of rats with CIA led to an amelioration of arthritis. These findings suggest that intraarticular transfection of NF-kappaB decoy ODN may provide a useful therapeutic approach for the treatment of inflammatory arthritis.

[An autopsy case of motoneuron disease with dementia of long duration]

An autopsy case of MND with dementia, 67 years old, man, was reported. The behavioral disturbance appeared at 61 years old, and was followed by the upper limb weakness and respiratory failure. He had remained on a respirator for 56 months. The total duration of the disease was 74 months, which was far longer than mean duration of the cases previously reported, 25-30 months. The pathological findings were about essentially identical to those mentioned before, such as cortical alterations in temporal and frontal lobes, neuronal loss with gliosis in amygdaloid body and substantia nigra, and loss of lower motoneurons in anterior horn of spinal cord and in the several motor cranial nerve nuclei. There were several Bunina bodies in the remnant lower motoneurons, but no changes in the pyramidal tracts or loss of Betz cells in the precentral gyrus. Intracytoplasmic ubiquitin-immunopositive inclusions in the granule cells of hippocampal dentate gyrus were also encountered, but the number of which did not increased, compared to the preceding data. There may be frequently little correlation between the disease duration and the number of such inclusions. The regional alteration in the intermediate zone between subiculum and entorhinal cortex was revealed also at the level of the splenium of corpus callosum. It has been reported that such parahippocampal lesion may initiate at the anterior part of temporal lobe and become undiscernible at more posterior level than the lateral geniculate body. The formation of such parahippocampal lesion may be concerning with the length of disease duration. In addition, there were numerous senile plaques, diffuse or neuritic type only in the parietal lobe cortex without any other changes.

Scaphoid nonunion and flexor pollicis longus tendon rupture

Four patients presented with a rupture of the flexor pollicis longus tendon that was associated with a longstanding scaphoid nonunion. A radiocarpal arthrosis was present in 3 of the 4 patients and a dorsiflexed intercalated segment instability deformity was also seen in 3 of the 4 patients. Three patients underwent surgery consisting of an osteosynthesis with an iliac bone graft for the scaphoid nonunion and a palmaris longus tendon graft for the ruptured flexor pollicis longus tendon. An osseous union of the scaphoid and a functional active range of motion of the thumb interphalangeal joint (33 degrees on average) was attained in all 3 of the patients treated surgically. Preoperative radiologic examinations and intraoperative findings suggest that the volarly protruding distal scaphoid segment is the cause of the rupture.

Age-dependent increase of IgE-binding and FcepsilonRI expression on circulating basophils in children

Peripheral blood basophils are sparse in the circulation, but they express high-affinity receptors for IgE (FCepsilonRI) and bind IgE efficiently. The present study was performed to elucidate the role of IgE bound on the basophil surface in the development of allergic responses during infancy and early childhood. IgE-binding and FcepsilonRI expression on basophils were evaluated by two-color flow cytometry. Basophil-bound IgE increased rapidly and reached adult levels during infancy in atopic patients, while it gradually increased with advancing age in parallel with serum IgE in normal controls. IgE-binding and FcepsilonRI expression in atopic children were higher than in normal controls among various age groups. They correlated with serum IgE levels but reached a plateau when serum IgE exceeded 300 ng/mL. A low, but significant level of FcepsilonRI expression was observed on cord blood basophils, although IgE-binding was usually undetectable. Incubation of cord blood with IgE rapidly saturated the preexisting IgE receptors and basophil-bound IgE levels increased. When neonatal basophils were cultured for 48 h with IgE, FcepsilonRI expression was upregulated dose-dependently and IgE-binding increased further. The up-regulation of FcepsilonRI was completely inhibited by cycloheximide, indicating that it was dependent on de novo protein synthesis. These results suggest that IgE-binding on basophils serves as a sensitive indicator of allergic sensitization, and that IgE functions as a positive regulator of FcepsilonRI expression in vivo.

Gastric toxicity related to perfusion of the stomach via the left inferior phrenic artery during hepatic arterial infusion chemotherapy: report of two cases

We present two cases of gastric toxicity related to hepatic arterial infusion chemotherapy (HAIC) for liver metastases. The gastric toxicity was caused by the inflow of infused drugs into the stomach via the left inferior phrenic artery arising from the celiac arterial trunk. The catheter hole was placed in the celiac arterial trunk with occlusion of the splenic and many gastric arteries. It must be kept in mind that perfusion of the stomach may occur through the left inferior phrenic artery in HAIC.

Relationship between joint effusion, joint pain, and protein levels in joint lavage fluid of patients with internal derangement and osteoarthritis of the temporomandibular joint

PURPOSE

The purpose of this study was to investigate the relationship between the presence of joint effusion, joint pain, and protein levels in joint lavage fluid (JL) of patients with internal derangement (ID) and osteoarthritis (OA) of the temporomandibular joint (TMJ).

PATIENTS AND METHODS

Thirty-eight joints in 26 patients with ID and OA of the TMJ were studied. Magnetic resonance imaging (MRI) evidence of joint effusion was evaluated in T2-weighted images. Samples of JL were collected from the superior joint space during pumping manipulation, and the protein concentration was measured. The presence of pain was based on joint tenderness or a complaint of pain in the preauricular region during mouth opening or closing.

RESULTS

Joint effusion was demonstrated in 20 of 25 (80%) painful joints; a significantly higher incidence than in pain-free joints (5 of 13, 38.5%). The mean protein concentration (2.15 mg/mL) in JL from painful joints was significantly higher than in pain-free joints (1.22 mg/mL) (P < .05). Furthermore, the mean protein concentration (2.12 mg/mL) in JL from joints with effusion was significantly higher than in joints without joint effusion (1.27 mg/mL) (P < .05).

CONCLUSIONS

These data demonstrate that painful joints are more likely to show joint effusion on MRI, and the protein levels in JL recovered from these joints is higher than in pain-free joints. These data also suggested that joint effusion may be related to the inflammatory changes seen in patients with ID and OA.

Trial of prophylactic administration of TXA2 synthetase inhibitor, ozagrel hydrochloride, for preeclampsia

OBJECTIVE

In an attempt to investigate the prophylactic effect of a thromboxane A2 (TXA2) synthetase inhibitor on pregnant women with a high risk of preeclampsia, the following clinical study was undertaken.

METHODS

Forty pregnant women were randomly allocated to control or treatment groups. Ozagrel Hydrochloride (400 mg/day, orally) and placebo were started at 20 weeks of gestation and continued until delivery.

RESULTS

Seventeen of 20 (85%) women in the control group developed preeclampsia, whereas 9 of 20 (45%) in the treatment group developed preeclampsia. Ozagrel Hydrochloride significantly (p < 0.01) reduced the occurrence of preeclampsia, and the incidence of both hypertension (p < 0.05) and proteinuria (p < 0.01) was significantly less in the treatment group compared with the control group. One month after administration, the mean plasma concentration of TXB2, a metabolite of TXA2, was significantly decreased (p < 0.01) to 62.4 +/- 13.6%, whereas that of 6-keto prostaglandin F1 alpha, a metabolite of PGI2, was significantly increased (p < 0.01) to 206.7 +/- 52.8%. There were no maternal or fetal side effects observed.

CONCLUSIONS

It seems likely that Ozagrel Hydrochloride could be used for the prevention of preeclampsia in high-risk pregnant women.

Functional analysis of retrotransposons in pea

The 5'-upstream regions of the plant active defense genes in pea (PSPAL2 and PSCHS1) exhibit significant nucleotide sequence identity to part of a copia-type retrotransposon. To characterize the retrotransposon in pea putative reverse transcriptase sequences (Psr) were amplified by PCR from cDNA prepared from protoplasts derived from pea suspension cultured cells. Psr genes can be classified into at least eight subgroups (A-H) according to their nucleotide sequence similarities. A subgroup PsrC was induced by the treatment of etiolated pea epicotyls with fungal elicitor within 30 min but was hardly induced by protoplasting of pea suspension cultured cells, whereas subgroups of PsrA and PsrB were highly induced by protoplasting. Interestingly, the retrotransposon sequence present at the 5'-upstream region of PSCHS1 which was induced by the treatment with fungal elicitor belonged to subgroup PsrC. The retrotransposon might play an important role in reorganization of the genes and optimization of the gene expression in response to various environmental stimuli such as an attack by phytopathogens or protoplasting.

Increased biological potency of hexafluorinated analogs of 1,25-dihydroxyvitamin D3 on bovine parathyroid cells

1,25-dihydroxyvitamin D3 (1,25-(OH)2D3) is known to be involved in regulating the proliferation of parathyroid cells and PTH synthesis through reactions involving its nuclear receptor. We evaluated the effects of 1,25-(OH)2D3 and its hexafluorinated analog, 26,26,26,27,27,27-hexafluoro-1,25-dihydroxyvitamin D3 (26,27-F6-1,25-(OH)2D3), on parathyroid cells. The 1,25-(OH)2D3 and 26,27-F6-1,25-(OH)2D3 each inhibited [3H]thymidine incorporation and ornithine decarboxylase (ODC) activity, which is important in cell proliferation, in primary cultured bovine parathyroid cells. The inhibitory effect of 26,27-F6-1,25-(OH)2D3 on PTH secretion from parathyroid cells was significantly more potent than that of 1,25-(OH)2D3 between 10(-11) M and 10(-8) M. Study of 26,27-F6-1,25-(OH)2D3 metabolism in parathyroid cells in vitro elucidated its slower degradation than that of 1,25-(OH)2D3. After 48 h of incubation with [1beta-3H]26,27-F6-1,25-(OH)2D3, two HPLC peaks, one for [1beta-3H]26,27-F6-1,25-(OH)2D3, and a second larger peak for [1beta-3H]26,27-F6-1,23(S),25-(OH)3D3, were detected. No metabolites were detected after the same period of incubation with 1,25-(OH)2[26,27-3H]D3. We observed that 26,27-F6-1,23(S),25-(OH)3D3 was as potent as 1,25-(OH)2D3 in inhibiting the proliferation of parathyroid cells. Data suggest that the greater biological activity of 26,27-F6-1,25-(OH)2D3 is explained by its slower metabolisms and by the retention of the biological potency of 26,27-F6-1,25-(OH)2D3 even after 23(S)-hydroxylation.

Thimet oligopeptidase cleaves the full-length Alzheimer amyloid precursor protein at a beta-secretase cleavage site in COS cells

We developed an assay method using a novel quenched fluorescent substrate (QFS) flanking the beta-cleavage site of amyloid precursor protein (APP), and purified a candidate beta-secretase from bovine brain. N-terminal amino acid analysis showed the candidate to be thimet oligopeptidase (TOP). The cDNA for human TOP was cloned from a human brain cDNA library and expressed in COS cells. The enzyme was further purified on a Ni2+-agarose column. TOP cleaved the Swedish Alzheimer's substrate (SEVNLDAEFR) as well as the normal substrate (SEVKMDAEFR). We then coexpressed TOP with APP695 in COS cells, collected transfected cells and conditioned media, and analyzed them by immunoblotting. The antibody against the specific secreted APP cleaved by beta-secretase (sAPPbeta) detected the secretion of sAPPbeta only from APP/hTOP-overexpressing cells, and not from cells overexpressing of antisense hTOP cDNA. Finally, we analyzed the immunolocalization of overexpressed hTOP in COS cells. Most hTOP was localized in the nuclei, but a small amount was localized in the Golgi or other organelles around the nuclei. These results suggest that TOP has a beta-secretase-like activity responsible for the processing of APP.

Growth hormone directly inhibits leptin gene expression in visceral fat tissue in fatty Zucker rats

Growth hormone (GH) is known to interact with adipose tissue and to induce lipolysis. Adipocytes produce leptin which regulates appetite and energy expenditure. In order to elucidate the role of GH in leptin production, we studied the effect of GH on leptin gene expression and body fat in fatty Zucker rats, a model of obesity with resistance to both leptin and insulin. Recombinant human GH administered subcutaneously at 0.5 mg/kg per day (low dose) as well as at 1.65 mg/kg per day (high dose) reduced leptin mRNA levels in epididymal fat tissue but not in subcutaneous fat tissue after 7 days. GH administration only at the high dose reduced percentage body fat. Insulin-like growth factor-I infusion (200 microg/kg per day) did not change percentage body fat or leptin mRNA levels in epididymal fat. These observations suggest that GH directly interacts with adipose tissue and reduces leptin gene expression in visceral fat tissue.

Hepatic arterial infusion chemotherapy using percutaneous catheter placement with an implantable port: assessment of factors affecting patency of the hepatic artery

OBJECTIVE

To assess the factors affecting patency of the hepatic artery during hepatic arterial infusion chemotherapy (HAIC) with an implantable port system inserted percutaneously.

PATIENTS AND METHODS

Ninety patients with malignant hepatic tumours were given HAIC using percutaneous catheter placement. An end-hole catheter was inserted into the hepatic artery (conventional method) in 41 patients. An end-closed and side-hole catheter was used in 49 patients, in which the catheter tip was fixed in the gastroduodenal artery and the side hole was placed in the common hepatic artery (fixed catheter-tip method). The patency of the hepatic artery was evaluated with computed tomography (CT) arteriography using the implantable port system and angiography. Then, the factors affecting hepatic arterial patency were analysed.

RESULTS

Hepatic arterial occlusion was observed in 15 patients (17%). The overall patency of the hepatic artery was 86.9%, 78.4% and 51.5% at 6 months, 1 year and 2 years, respectively. The patency rate of the hepatic artery was significantly higher in patients with catheter placement using fixed catheter-tip method than those using conventional method (P = 0.01), and in patients without transcatheter arterial chemoembolization (TACE) prior to catheter placement than those with prior TACE (P = 0.01). When the variables affecting patency of the hepatic artery were studied together by multivariate analyses, the important factors were the method of catheter placement and the presence or absence of prior TACE.

CONCLUSION

We consider that it is important for long-term patency of the hepatic artery during HAIC to use fixed catheter-tip method for percutaneous catheter placement instead of conventional method, and to select patients without prior TACE.

Kinetic Study of Lead Adsorption to Composite Biopolymer Adsorbent

A kinetic study of lead adsorption to composite biopolymer adsorbents was carried out. Spherical and membranous adsorbents containing two biopolymers, humic acid and alginic acid, were used for lead adsorption in dilute acidic solutions. The shrinking core model derived by M. G. Rao and A. K. Gupta (Chem. Eng. J. 24, 181, 1982) was applied to describe the rate process of lead adsorption to spherical adsorbents (average radii of 0.12, 0.15, and 0.16 cm). Furthermore, the shrinking core model was modified and adapted for description of the rate process of lead adsorption to membranous adsorbent (average thickness of 0.0216 cm). The adsorption rate process for the both cases was well described and average apparent lead diffusion coefficients of about 6 x 10(-6) and 7 x 10(-6) cm2 s-1 were found for the spherical and membranous adsorbents, respectively. Copyright 1999 Academic Press.

Interaction between leptin and growth hormone (GH)/IGF-I axis

In order to identify the mutual interaction between GH and leptin, we studied the effect of GH on fatty Zucker rats. GH administration at a high dose (5.0 IU/kg) reduced % body fat after 7 days. The leptin mRNA level in subcutaneous fat tissue was not changed but that in epididymal fat tissue was decreased by an even lower dose of GH (1.5 IU/kg). IGF-I treatment (200 microg/kg/day) did not change the % body fat or leptin mRNA level. These observations suggest that GH directly interacts with visceral fat and reduces fat mass and leptin expression. We also measured serum leptin levels in patients. The levels in patients with acromegaly were significantly lower than those in normal subjects with the same amount of body fat, but serum IGF-I and urinary C peptide excretion rates were higher in the acromegalic. These observations also suggests that GH directly interacts with adipose tissue and reduces leptin expression. Next we investigated the direct action of leptin on GH release from the pituitary. Leptin pretreatment of pituitary cells in culture or rats in a fasted or fed condition did not change GRH induced GH secretion. As indicated also by other recent studies, leptin may increase GRH or decrease somatostatin secretion by the hypothalamus. Thus GH interacts with fat tissues and leptin may be a good marker of the interaction.

Antimicrobial activities of cefditoren against respiratory pathogens isolated from children in Japan

There is an increasing spread and incidence of penicillin-resistant bacteria that are becoming less susceptible to commonly prescribed oral antimicrobials, including extended-spectrum cephalosporins. Against this background, we undertook this study to determine the prevalence of penicillin resistance in Streptococcus pneumoniae and the in-vitro activity of oral antimitrobials. Between April 1996 and December 1997, in 245 children with respiratory tract infections (bronchitis in 61, pharyngitis in 115, and tonsillitis in 69), 119 strains of Haemophilus influenzae, 89 strains of Streptococcus pyogenes, 61 strains of Streptococcus pneumoniae, 36 strains of Staphylococcus aureus, and 34 strains of Moraxella catarrhalis were isolated from the pharynx. The antimicrobial susceptibility of these isolates was assessed by a broth microdilution method. The isolation incidence of penicillin-intermediately resistant S. pneumoniae (PISP) and penicillin-highly resistant S. pneumoniae (PRSP) was 59.0% and 13.1%, respectively. Most strains of PISP and PRSP were highly resistant to cefaclor, cefpodoxime, cefteram, cefdinir, clarithromycin, ampicillin, and minocycline, but susceptibile to ofloxacin and cefditoren (CDTR). The in-vitro activity of CDTR was superior to that of other cephalosporins, such as cefaclor, cefdinir, and cefpodoxime, when tested against both the beta-lactamase-positive and -negative H. influenzae isolated. CDTR was also active against all the other strains, including methicillin-sensitive S. aureus, S. pyogenes, and M. catarrhalis. This study suggested that CDTR was a useful oral antibiotic for pediatric respiratory tract infections.

Changes in in vivo DNA-protein interactions in pea phenylalanine ammonia-lyase and chalcone synthase gene promoter induced by fungal signal molecules

Elicitor-induced protein bindings were detected on the several particular sequence motifs in two members of the pea PAL and CHS gene promoters by in vivo footprinting analyses. However, elicitor-induced changes rapidly reverted back to the uninduced pattern after the subsequent application of suppressor from M. pinodes.

Peroneal nerve palsy caused by intraneural ganglion

A case of peroneal nerve palsy caused by an intraneural ganglion is presented. The cystic mass was located posterolateral to the lateral femoral condyle and extended along the common peroneal nerve distal to the origin of the peroneus longus muscle. The nerve was compressed in the narrow fibro-osseous tunnel against the fibula neck and the tight origin of the peroneus longus muscle. The nerve was decompressed by complete tumor excision and transection of the origin of the peroneus longus muscle. Full recovery of nerve function was obtained in 6 months.

Increasing prevalence of ampicillin- resistant, non-beta-lactamase-producing strains of Haemophilus influenzae in children in Japan

Among Haemophilus influenzae isolated from children with respiratory tract infections, the evolution of ampicillin resistance was investigated during 1996 and 1997 in Japan. beta-Lactamase production was assessed and minimum inhibitory concentrations (MICs) of eight antimicrobial agents were determined using a broth microdilution method in Mueller-Hinton-lysed horse blood medium. Of 74 H. influenzae, 11 strains (14.9%) produce beta-lactamase and were thus highly resistant to ampicillin (MIC of >4.0 microgram/ ml). In addition, moderate resistance to ampicillin, defined as an MIC of >==1.0 microgram/ml, was noted in 44.4% of all beta-lactamase-negative isolates. These beta-lactamase-negative ampicillin-resistant (BLNAR) organisms were resistant to other cephalosporins such as cefpodoxime and cefdinir, while beta-lactamase-producing strains were susceptible to them. Cefditoren, cefteram, and minocycline were active against all strains studied, whereas cefaclor and clarithromycin were inactive against all H. influenzae isolates in this study. Results indicate that BLNAR strains have emerged among children with respiratory tract infections in Japan.

Development of extrahepatic arterial blood supply to the liver during hepatic arterial infusion chemotherapy

The aim of this study was to evaluate the correlation of development of the collateral circulation to the liver during hepatic arterial infusion chemotherapy (HAIC) with the presence of hepatic tumours adjacent to the hepatic surface, and with pretreatment occlusion of aberrant hepatic arteries. In 102 patients with unresectable malignant hepatic tumours treated with HAIC using an implantable port system, development of collaterals to the liver was assessed with CT arteriography using the implantable port and pre- and postoperative angiography. Aberrant hepatic arteries, if present, were occluded prior to treatment for hepatic arterial redistribution. Collaterals to the liver were seen in 29 patients, who had 35 areas with collateral perfusion: 22 areas were in the right posterosuperior area, 6 in the left peripheral area and 7 in the right or left lobar area. Collaterals were revealed more frequently in patients with hepatic tumours adjacent to the hepatic surface than in those without hepatic tumours in peripheral areas in the liver (p < 0.0001). In addition, collaterals developed more frequently in patients with an aberrant hepatic arterial anatomy compared with those with conventional anatomy (p = 0.0007). Our results indicated that patients with hepatic tumours adjacent to the hepatic surface and with pretreatment occlusion of aberrant hepatic arteries had the potential to develop collaterals to the liver during HAIC.

Safety evaluation of Nostoc flagelliforme (nostocales, Cyanophyceae) as a potential food

The safety of the alga genus Nostoc flagelliforme Born. etFlah. as a human food source was evaluated in an oral acute toxicity study and in a 28-day oral subacute toxicity study using rats. In the acute toxicity study, the dried powder of N. flagelliforme was orally administered to male and female rats at a dose of 1250 mg/kg and 2500 mg/kg. Neither mortality nor changes in general condition were observed in either the study groups or the control group over a 14-day observation period. In the subacute toxicity study, N. flagelliforme powder was administered orally to male and female rats at a dose of 500 mg/kg and 1000 mg/kg for a period of 28 days. Neither mortality nor changes in general condition were observed in either the treatment group or the control group throughout the 28-day administration period. No reduction in food consumption or body weight gain was observed in the experimental animals. Ophthalmological tests performed at the end of the administration period revealed no abnormalities within the ophthalmological parameters. In the haematological tests and serum biochemical tests performed at the time of completion of the administration period, no adverse effects of N. flagelliforme were observed. At autopsy, organ weight at the end of the experimental period and histopathological tests of specimens obtained from the autopsied animals revealed no significant influences of N. flagelliforme. In conclusion, considering the absence of adverse effects of N. flagelliforme in this study, findings in the oral acute toxicity study and the 28-day oral subacute toxicity study may indicate the safety of N. flagelliforme for human consumption. This study is in agreement with the novel nutraceutical idea "Phycophagism".

No increase in cerebrospinal fluid tau protein levels in patients with vascular dementia

Tau protein levels in cerebrospinal fluid (CSF-tau) were determined in 29 patients with old cerebrovascular disease (CVD, 21 demented and eight non-demented), 69 patients with Alzheimer's disease (AD) and 17 age-matched normal controls. The CSF-tau level in the vascular dementia (VD) group (24.0 +/- 17.0 pg/ml) was significantly lower (P < 0.0001) than that in the AD group (90.0 +/- 45.3 pg/ml), but not significantly different from that in the non-demented patients with CVD (18.1 +/- 10.2 pg/ml) or controls (20.3 +/- 13.0 pg/ml). Among the VD patients, 1/21 exceeded a cut-off value (mean +/- 2 SD of controls), whereas 8/69 of the AD patients had CSF-tau levels below this value. These findings suggest that VD constitutes a group of dementias that can be separated from AD by normal CSF-tau levels. CSF-tau determinations in combination with other clinical findings may provide another diagnostic aid in the differential diagnosis between VD and AD.

[Continuous arterial infusion of protease inhibitor with supplementary therapy for the patients with severe acute pancreatitis--clinical effect of arterial injection of ulinastatin]

We treated five patients with severe acute pancreatitis by continuous arterial infusion (CAI) of protease inhibitor, nafamostat mesilate. Arterial injection (AI) of ulinastatin was performed in four cases and AI of antibiotics (IPM/CS) was done in one case, as supplemental therapies of CAI. Abdominal pain disappeared in 7.9 hours on the average, abdominal tenderness disappeared in 5.0 days and laboratory data lately recovered. All five cases treated by these therapies were cured without hemodialysis or surgical treatment in acute phase. AI of ulinastatin through arterial infusion catheter is pharmacokinetically more effective, because it yields a relatively high concentration of the drug at the acting site when compared with that of intravenous injection. Furthermore ulinastatin inhibits different types of protease from nafamostat mesilate. Therefore the clinical effect of CAI of nafamostat mesilate is enhanced by the combined therapy with AI of ulinastatin. It is also suggested that arterial injection of ulinastatin might be effective for the control of abdominal pain and that arterial injection of antibiotics might have an advantage on prevention of infectious pancreatic necrosis.

Persistent subchorionic hematoma with clinical symptoms until delivery

OBJECTIVE

This study was performed retrospectively to clarify the clinical features of persistent subchorionic hematoma with clinical symptoms until delivery.

METHODS

We studied all the 22 cases of persistent subchorionic hematoma with symptoms until delivery from 4763 singleton pregnant women delivered in our hospital from 1985 to 1996 inclusive to investigate their clinical course and pregnancy outcome.

RESULTS

The initial symptom of subchorionic hematoma was vaginal bleeding and/or uterine contractions. The onset of the symptoms showed two peaks at 9-11 and 30-31 weeks of gestation. The pregnancy outcome was spontaneous abortion in three cases (13.6%), premature labor in 17 cases (77.3%) or full-term delivery in two cases (9.1%). Tocolysis was needed in 17 of the 22 cases (77.3%), of which 16 cases failed to prevent premature delivery.

CONCLUSION

Persistent subchorionic hematoma with clinical symptoms until delivery is likely to result in abortion or premature labor, because that may be thought to be a severe type.

Biosorption of Heavy Metal Ions to Brown Algae, Macrocystis pyrifera, Kjellmaniella crassiforia, and Undaria pinnatifida

A fundamental study of the application of brown algae to the aqueous-phase separation of toxic heavy metals was carried out. The biosorption characteristics of cadmium and lead ions were determined with brown algae, Macrocystis pyrifera, Kjellmaniella crassiforia, and Undaria pinnatifida. A metal binding model proposed by the authors was used for the description of metal binding data. The results showed that the biosorption of bivalent metal ions to brown algae was due to bivalent binding to carboxylic groups on alginic acid in brown algae. Copyright 1998 Academic Press.

A case of glycogen storage disease type Ia with multiple hepatic adenomas and G727T mutation in the glucose-6-phosphatase gene, and a comparison with other mutations previously reported

We report a case of 23-yr-old man with glycogen storage disease (GSD) type Ia complicated by multiple hepatic adenomas. Analysis of the G-6-Pase gene using peripheral blood sample showed this patient to be homozygous for a G-to-T transversion at nucleotide 727 in exon 5. This mutation is prevalent among Japanese patients, suggesting that specific genotypes may correlate with different clinical courses or outcomes.

Developmental changes and functional properties of human memory T cell subpopulations defined by CD60 expression

The present study was undertaken to examine developmental changes of T cells expressing CD60 and their functional properties. Three-color immunofluorescence analysis revealed that the CD60 antigen was preferentially expressed on a proportion of memory (CD45RO+) CD4+ T cells, but less on memory CD8+ T cells, while this antigen is undetectable in naive (CD45RO-) T cells. A frequency of memory CD4+ T cells expressing CD60 in the peripheral blood was negligible in newborns and gradually increased with advancing age. CD60+ memory CD4+ T cells showed stronger proliferative responses to PPD and produced higher levels of IL-4 and IL-10 than CD60- ones, whereas production of IL-2 and IFN-gamma was similarly found in both cell subpopulations. In addition, it was shown that efficient helper activity for Ig production by B cells was predominated in CD60+ memory CD4+ T cells. These results suggest that CD60 may be primarily expressed on the functionally differentiated memory effector cells among circulating CD45RO+ CD4+ T cells.

Quantitative MRI of hepatocellular carcinoma in cirrhotic and noncirrhotic livers

Magnetic resonance imaging (MRI) of hepatocellular carcinoma (HCC) in cirrhotic and noncirrhotic livers was reviewed in 26 Japanese patients. Thirteen of the 15 HCC from noncirrhotic livers were iso- to low intense to surrounding parenchyma on T1-weighted spin-echo (SE) images. In contrast, seven of the 11 HCC in cirrhotic livers were high intense (p < 0.05). Signal intensity ratio and contrast-to-noise ratios of HCC in cirrhotic livers on T1-weighted images were higher (p < 0.05 and p < 0.01, respectively) than those of HCC in noncirrhotic livers.

Spinal canal involvement in infantile myofibromatosis: case report and review of the literature

PURPOSE

An unusual case of infantile myofibromatosis with spinal canal involvement is reported and the literature is reviewed.

PATIENT AND METHODS

A female neonate had bladder and bowel dysfunction and paresis of the lower extremities.

RESULTS

Intrapelvic and paravertebral masses with extension into the spinal canal were detected by imaging studies. In addition, radiologic examination showed multiple metaphyseal radiolucent lesions of the long bones and pathologic fracture of the left femur. The histopathologic diagnosis of the paravertebral tumor and bone lesions was infantile myofibromatosis. Surgical resection of the paravertebral and intrapelvic masses was performed to improve her neurologic impairments. Paresis of the lower limbs gradually improved, whereas bladder and bowel dysfunction remained unchanged.

CONCLUSIONS

Only six cases of infantile myofibromatosis associated with spinal canal involvement have been reported. Three patients with flaccid paresis of extremities and respiratory distress died in the newborn period. The other three patients showed improvement of the paresis. The prognosis of infantile myofibromatosis without visceral complication is generally good, but neurologic impairment may occur at birth if the spinal cord is compressed.

Repeated percutaneous aspiration therapy prior to surgery for a pancreatic pseudocyst: report of a case

We describe herein the case of a patient with a giant pancreatic pseudocyst which was first treated with repeated percutaneous aspiration therapy, then cured surgically by a Roux-en Y cystojejunostomy, 26 weeks after its formation. A 41-year-old man developed alcohol-induced acute severe pancreatitis. Computed tomography (CT) performed 10 weeks after the onset revealed a giant cyst, 20 x 18 x 7cm in size, arising from the body and tail of the pancreas and extending to the left loin. Endoscopic retrograde pancreatography (ERP) showed a normal main pancreatic duct without communication to the pseudocyst. As the asymptomatic pseudocyst, the wall of which was less than 2mm thick, had not resolved by 8 weeks after its formation, percutaneous aspiration therapy was performed three times. The patient was treated as an outpatient without any complications. The cyst wall was subsequently confirmed to be mature enough for surgical management to be initiated, and a cystojejunostomy was safely performed. Thus, percutaneous aspiration therapy can enable the surgeon to observe maturation of the cyst wall for a long period in patients with a pancreatic pseudocyst.