Treatment of Takayasu's aortitis with self-expanding metallic stents (Gianturco stents) in two patients

Gianturco self-expanding metallic stents were successfully placed to treat incomplete balloon dilatation of the abdominal aorta in 2 patients with Takayasu's aortitis. In 1 case eleven 1-cm long, 1-cm diameter stents were inserted in tandem to bridge a long stenosis. In the other patient, four stents 1.5 cm long, 1.5 cm in diameter were inserted in tandem to bridge what had been a complete occlusion prior to balloon angioplasty. Clinical symptoms, as well as angiographic findings, improved significantly after placement of the stents. The patients underwent repeat aortography at 10 and 8 months, respectively, and were followed clinically for a total of 18 months and 15 months, respectively, without clinical evidence of deterioration. Our results show the usefulness of expandable metallic stents in the treatment of aortic stenosis due to Takayasu's aortitis that remains unresponsive to balloon dilatation.

Three-dimensional black blood MR angiography of the liver during breath holding. A comparison with two-dimensional time-of-flight MR angiography

In 2-D time-of-flight MR angiography (2-D TOF MRA) of the liver, artifacts caused by respiratory motion are unavoidable. Therefore, a 3-D black blood MRA of the liver was attempted in 7 healthy volunteers, using a 3-D gradient echo sequence which allows imaging during breath holding. 2-D TOF MRA was performed as well. In all subjects, 3-D MRA allowed visualization of the trunk, 1st-, and 2nd-order branches of the portal vein without interruption. Right 3rd-order branches were visualized without interruption in 6 of 7 subjects (85%). However, with 2-D MRA, the transverse portion of the left main portal vein could not be visualized in any subject, and the periphery of the portal vein was less clear than with 3-D MRA.

[Two cases of pulmonary hypertrophic osteoarthropathy associated with primary lung cancer, in which symptoms were rapidly improved by resection of the primary lesions]

Pulmonary hypertrophic osteoarthropathy (PHO) is a syndrome of unknown etiology, presenting with osteitis of the long bones, arthritis, and clubbing of digits, associated with lung cancer or other chronic pulmonary or pleural diseases. Although about 3-10 percent of cases of lung cancer were reported to be associated with PHO in USA or Europe, reports of these cases are relatively rare in Japan. We report two cases of PHO associated with primary lung cancer, in which symptoms were rapidly improved by resection of the primary lesions. Both cases were poorly differentiated adenocarcinoma of the lung (pT2N0M0, Stage I). The bone and joint pain rapidly improved soon after the resection of the primary lesions. The abnormal findings of bone scan and bone X-ray film subsequently improved. In the 2nd case, radionuclide imaging more clearly revealed the presence and extent of subperiosteal activity than radiography. Radionuclide disclosure of PHO was considerably more sensitive than radiography.

Protective action of putrescine against rat liver injury

The hepatoprotective action of orally dosed putrescine was investigated using rat models of liver injury. When rats received putrescine orally soon after a dose of carbon tetrachloride or D-galactosamine, deranged serum alanine aminotransferase values and prothrombin times were significantly attenuated compared with control levels, with improved histologic extent of liver injury. Putrescine addition to the medium of rat hepatocytes in primary culture reduced cell killing induced by D-galactosamine or the membrane detergents chenodeoxycholic acid and Triton X-100. Similar reduction was seen in cells exposed to tert-butyl hydroperoxide (TBHP), an agent producing cell death through lipid peroxidation, with attenuation of cellular malondialdehyde content. Putrescine also significantly attenuated the extent of increased plasma membrane microviscosity as assessed with 1-[4-(trimethylammonio)phenyl]-6-phenyl-1,3,5-hexatriene in TBHP-treated cells. These results suggest that orally given putrescine protects against liver injury. Plasma membrane stabilization and reduction of lipid peroxidation may contribute to this hepatoprotection.

Expression of the Bacillus subtilis spoIVCA gene, which encodes a site-specific recombinase, depends on the spoIIGB product

The Bacillus subtilis spoIVCA gene encodes a site-specific recombinase which creates a sigK gene by DNA rearrangement. We have determined the transcription initiation point of the spoIVCA gene and found that (i) the spoIVCA promoter contains sequences which are similar to -10 and -35 regions of promoters recognized by sigma E and (ii) mutation of spoIIGB, which encodes pro-sigma E, blocked the expression of spoIVCA.

The effect of CO2-induced acid-base changes on the potencies of muscle relaxants and antagonism of neuromuscular block by neostigmine in rat in vitro

We investigated the influence of CO2-induced acid-base changes on the potencies of the monoquaternary relaxants (rocuronium, vecuronium, and d-tubocurarine) and bisquaternary relaxants (pancuronium, pipecuronium, and metocurine), and on the antagonism of their neuromuscular block by neostigmine. Phrenic nerve-hemidiaphragm preparations of rats were used. The pH changes were induced by changing the CO2 concentration aerating the modified Krebs solution. The potencies of the monoquaternary relaxants increased at 9% CO2 (pH 7.2) and decreased at 2.5% CO2 (pH 7.6) from those of 5% CO2 (pH 7.4) both with and without neostigmine (P < 0.05), whereas the potencies of the bisquaternary drugs did not change significantly at different pH levels from control (pH 7.4) both with and without neostigmine. The slopes of the log concentration-percent response curves of each drug were not significantly different at each pH level. The ratios of inhibitory concentrations, 50% (IC50) values with and without neostigmine at each pH value for each drug were not significantly different indicating that the neostigmine-induced antagonism for each drug was not affected by the CO2-induced acid-base changes. But the ratios of the IC50 values of the steroidal relaxants (rocuronium, vecuronium, pancuronium, and pipecuronium) were significantly lower (P < 0.05) than those of the isoquinolinium drugs (d-tubocurarine and metocurine) at each pH level, suggesting that the antagonism is enhanced at each pH level for the isoquinolinium relaxants. The difference was independent of their monoquaternary or bisquaternary nature. These results suggest that CO2 increases the potency of the monoquaternary relaxants but does not affect the bisquaternary relaxants.(ABSTRACT TRUNCATED AT 250 WORDS)

Symptoms and social adjustment of schizophrenic patients as evaluated by family members

The purpose of this study is to reveal the relationship between family expressed emotion (EE) and family evaluation for symptoms and social adjustment of schizophrenic patients. Chronic schizophrenic outpatients in offshore islands under stationary therapeutic conditions were studied. For evaluation, the Five Minute Speech Sample (FMSS) for EE and the Katz Adjustment Scale (KAS) for family evaluation of patients were used. EE level was high among relatives who thought the patient was belligerent, negativistic, unstable or helpless. High-EE relatives tended to evaluate their patients' performance of social activities rather low and showed strong dissatisfaction with the patient's leisure activities. Moreover, a high emotional overinvolvement (EOI) value is more common in Japan than in other countries. A subgroup of the FMSS-EOI, the emotional display, was seen where many mothers began to cry while speaking.

[Manometric study of the biliary sphincter zone: a comparison between the length of phasic activity and the narrow distal segment]

Motor activity of the sphincter of Oddi has been evaluated in 26 patients who underwent ERCP examination. Manometric recordings from the common bile duct and the sphincter of Oddi were performed with a single end-lumen perfused catheter. The number of successive 3 mm spaced black marks, observed during the pull-through from the first appearance of the proximal sphincter activity to that of duodenal pressure, was used to measure the length of the sphincter zone. In 14 of 26 patients, the length of phasic activity zone of the sphincter of Oddi was 9 mm. However, the narrow distal segment of the common bile duct was 15.1 +/- 3.6 mm in length. In same patients, the length of phasic activity zone was shorter than the anatomical one. The mean sphincter of Oddi pressure (SOP) at the distance of 6 mm from the papillary pore (77.8 +/- 22.1 mmHg) was greater than that of 9 mm (58.4 +/- 27.0 mmHg) and 12 mm (51.0 +/- 16.9 mmHg). These results suggest that the location of the orifice of catheter should be taken into consideration when comparing the SOP.

Tissue characterization of pneumonia and irradiated rat lungs with magnetic resonance relaxation times

To interpret the MRI signal intensities, the T1 and T2 values were determined in vitro for rat lungs with radiation pneumonitis, fibrosis or pneumonia, and also for muscle and fat tissues. The transverse magnetization decays mentioned above exhibited two components, a T2 fast (T2f) and a T2 slow (T2s) component. Lungs from rats with pneumonia had significantly longer T2f and T2s values than lungs from rats with radiation pneumonitis and fibrosis. The T2f and T2s values for a "pneumonia lung" were not significantly different from those of muscle. The measured values of T2f and T2s suggested that radiation pneumonitis and fibrosis likely exhibit lower signal intensities than do muscle and that a "pneumonia lung" likely exhibits a similar signal intensity to that of muscle on T2-weighted MR images.

Prospective and randomized controlled study of chemoembolization therapy in patients with advanced hepatocellular carcinoma. Cooperative Study Group for Liver Cancer Treatment in Shikoku area

The Cooperative Study Group conducted a study to assess the therapeutic effects of chemoembolization in patients with advanced hepatocellular carcinoma (HCC) using either epirubicin hydrochloride (FARM) or doxorubicin hydrochloride (ADR). A total of 77 patients were enrolled in this study and randomized into 2 groups: 39 patients were treated with a FARM solution as the material for Lipiodol-transcatheter arterial embolization (TAE; FARM group), and 38 patients were treated with an ADR solution as the material for L-TAE (ADR group). For the FARM group, the 1-year survival rate was 69.9% and the 2-year survival rate was 44.5%. For the ADR group, the corresponding survival rates were 74.7% and 44.0%. The differences among the above figures were not statistically significant. As side effects, fever, nausea, and generalized fatigue occurred at almost the same frequencies in the two groups. Changes detected in the liver function and the peripheral blood cell count in both groups were not severe. There was no significant difference between the toxic effects observed in the two groups. In conclusion, there was no significant difference in therapeutic efficacy between the FARM and ADR groups.

Repeated arterial infusion chemotherapy for inoperable hepatocellular carcinoma using an implantable drug delivery system

Arterial infusion chemotherapy has become one of the major treatments for malignant tumors. Since 1988, we have attempted repeated arterial infusion of anticancer drugs using an implantable drug delivery system in 68 patients who had inoperable hepatocellular carcinoma (HCC). Most of our patients could not undergo transcatheter arterial embolization (TAE) because of extreme tumor extension and/or accompanying advanced liver cirrhosis. In most patients we implanted a 5-F catheter via the femoral artery nonsurgically and connected it to a subcutaneously implanted drug delivery system without any difficulty. The treatment consisted of weekly or biweekly intrahepatic one-shot administration of anticancer drugs. As one therapeutic regimen, epirubicin was given alone. Other regimens consisted of combined chemotherapy using two or more of the following drugs: mitomycin C. Adriamycin, 5-fluorouracil, cisplatin, and epirubicin. In some cases, these drugs mixed with Lipiodol were given for targeting and slow release in the liver. The response rate (CR+PR) of the cases was 25.0%. The median survival period was 389.9 days. The 6-month, 1-year, and 2-year survival rates were 75%, 45%, and 17%, respectively. There was no severe side effect or complication except arterial occlusion that precluded further infusion chemotherapy. We think that the implantable drug delivery system will contribute not only to improved therapeutic efficacy for inoperable HCC but also to an improved quality of life for the patients.

Hepatitis C virus plus- and minus- strand RNA in hepatocellular carcinoma and adjoining nontumorous liver

The presence of hepatitis C virus (HCV) RNA in serum and liver tissue was examined in seven patients with hepatocellular carcinoma (HCC), using the reverse transcriptase-polymerase chain reaction method with primers for the 5'-noncoding region. Plus-strand HCV-RNA was detected in the serum and liver tissue (both cancerous and noncancerous tissue) of all five patients who were positive for anti-HCV antibodies (C100-3 and P22) and was not detected in both of two patients who were negative for anti-HCV antibodies. Minus-strand HCV-RNA was only detected in the liver tissue (cancerous and noncancerous portion) of the five anti-HCV antibody-positive patients. The relative liver tissue content of minus-strand HCV-RNA ranged from 1 to 100 time less than that of plus strand HCV-RNA in cancerous and noncancerous tissue in each patient, respectively. There was no similar tendency in the HCV-RNA content between the cancerous and noncancerous portions of the liver in each patient. These results suggest that HCV exists and replicates in HCC tissue and may have some role in the development of HCC.

Acute eosinophilic pneumonia evaluated with high-resolution computed tomography

We describe two cases of acute eosinophilic pneumonia (AEP) presenting with high fever and hypoxia of acute onset with bilateral interstitial infiltrates on chest roentgenograms. Diagnosis was confirmed in each case by bronchoalveolar lavage and transbronchial lung biopsy in which the pathologic process was limited to the lung interstitium. High-resolution computed tomography (HRCT) of the thorax at the height of the disease process revealed peripheral ground-glass opacities along the bronchovascular bundles. Symptoms and radiologic abnormalities resolved spontaneously within two weeks. The HRCT-findings may reflect the pathologic process in AEP and the ground-glass opacities likely indicate spontaneous resolution without corticosteroid therapy.

Ability of hydroxyapatite-bone morphogenetic (corrected from morphologenetic) protein (BMP) complex to induce dentin formation in dogs

This histological investigation examined the formation and differentiation of pulp cells under the influence of HAP/BMP complex. HAP/BMP complex was implanted in exposed pulp of the mandibular premolars and alveolar bone defect in the dog. Sequential changes in these areas were examined mainly under a light microscope and partly under a scanning electron microscope. Two weeks after the operation, fibroblast-like cells proliferated right beneath the implanted complex, and after 3 weeks, dentin including dentin tubules grew in the pulp. After four weeks a dentin bridge composed of osteoid dentin was found, and after 8 weeks this dentin calcified and covered the defective surface of the root and adhered to new bone surrounding the HAP granules. The results indicated that the dentin induced by HAP/BMP complex may be of two types: tubular dentin and osteodentin. This complex exhibited outstanding ability to induce dentinogenesis and osteogenesis.

Prevalence of risk factors for sleep apnea in Japan: a preliminary report

A final goal of the present study is to estimate the prevalence of sleep apnea in the general population of Japan. As the first step, the detailed questionnaires were sent out to the presumably healthy subjects who underwent regular medical checkups at four hospitals in different cities of Japan. The questionnaires included queries about difficulties in initiating and maintaining sleep, habitual snoring, parasomniac symptoms, excess daytime sleepiness, any present illness, consumptions of cigarettes and alcohol and so on. A total of 3,243 replies were obtained so far (2,029 male and 1,214 female; mean age = 50 years). The results were consistent among the four hospitals, and the prevalences of risk factors were as follows: habitual snoring was reported by 12.8-16.0%, excess daytime sleepiness by 8.1-9.4% and frequent awakenings by 7.3-12.6%, respectively. The prevalence of systemic hypertension ranged from 5.3% to 12.9%. Polysomnographic studies are being performed on the possible cases of sleep apnea who were sorted out by the questionnaires.

[Sleep-disordered breathing in Japan: an overview]

Questionnaires were answered by 3,243 presumably healthy subjects who underwent regular medical checkups in four cities. The prevalences of risk factors for sleep-disordered breathing (SDB) were as follows; habitual snoring was reported by 13-16%, excessive daytime sleepiness by 8-9%, insomnia by 7-13% and systemic hypertension by 5-13%. Polysomnographic studies performed on some possible SDB cases who were selected by the presence of risk factors estimated that the average prevalence of SDB in the present population would be in the range of 1.14-1.94%. Secondly, questionnaires were sent to the main hospitals and institutes involved in the management of patients with SDB, asking about diagnostic criteria, number of SDB patients, management, effectiveness of treatment, etc. The total number of patients registered at those hospitals was 2,751 in 1991. Of the 132 patients who were followed for more than six months, the efficacies of body weight loss, medications, nasal CPAP and UPPP were compared. Based on the analyses of the 279 patients examined some tentative vriteria for diagnosis and for treatment are proposed.