Case reports on a porous alumina ceramics implant: observations at 14 years after treatment

Bioceram Porous Implants using alumina are manufactured by Kyocera Corp. We started to use this implant in September of 1984. The subjects were 18 men and 42 women 20 to 70 years of age. We have followed up 65 implants in 60 patients for up to 13 years and 6 months. One implant in 1 patient had to be removed because of post-operative infection and 4 implants in 4 patients had to be removed due to fracturing or detachment. The clinical progress has been good in all the other 60 implants in 55 patients.

Expression of Fos in the rat forebrain following experimental tooth movement

Orthodontic tooth movement is known to cause pain and discomfort to patients. Mechanically induced inflammatory responses in the periodontium are assumed to be related to the mechanism of pain sensation. An immediate-early gene, c-fos, that is expressed within some neurons following synaptic activation, is widely used as a marker for neuronal activity following noxious or innocuous stimulation. We have recently demonstrated that experimental tooth movement produced Fos induction in the ipsilateral trigeminal subnucleus caudalis and in the bilateral lateral parabrachial nucleus, which is known to be involved in the transmission of nociceptive information. As a further step, we investigated the distribution of Fos-like immunoreactive neurons in the upper brain regions. Twenty-four hours after the commencement of the experimental tooth movement, the Fos-like immunoreactive neurons appeared in the central nucleus of the amygdala (Ce), paraventricular nucleus of the hypothalamus (PVH), and paraventricular nucleus of the thalamus (PV) of the experimental rats. The numbers of the labeled neurons were significantly increased by 639% (P < 0.001) and 644% (P < 0.001) in the ipsilateral and contralateral sides of the Ce, respectively, by 292% (P < 0.001) and 307% (P < 0.001) in the ipsilateral and contralateral sides of the PVH, and by 264% (P < 0.0001) in the PV with respect to sham control rats. These results suggest that nociceptive information caused by experimental tooth movement might be transmitted and modulated in several regions of the forebrain.

A cross-sectional study on the relationship between depression and left ventricular hypertrophy

BACKGROUND

Despite a large number of studies, the relationship between depression and cardiovascular disease remains ambiguous. This study is the first to investigate the relationship between depression and left ventricular hypertrophy (LVH) as detected by electrocardiogram.

METHODS

The subjects were 346 male Japan Self-Defense Forces personnel ages 49 to 55 years. LVH was assessed by electrocardiogram. Depression was measured by the Self-Rating Depression Scale (SDS). Other selected risk factors were measured. Odds ratios for LVH in relation to selected variables were calculated. A logistic regression analysis was used to adjust for possible confounding variables.

RESULTS

High level of depression (SDS score > or = 34) showed a high risk of LVH occurrence. After adjusting for BMI, systolic blood pressure, and/or diastolic blood pressure, there was a tendency toward a positive association of LVH with high level of depression.

CONCLUSIONS

Our present study demonstrated that depression is closely related to LVH. Since LVH could be a predictor of fatal cardiovascular disease, this is of direct relevance to the prescription of preventive measures.

Unusual variant of left paraduodenal hernia herniated into the mesocolic fossa leading to jejunal strangulation

Paraduodenal hernia is a rare condition in which the small bowel loops are herniated into an unusual fossa in the periduodenal area. We treated a patient with paraduodenal hernia diagnosed preoperatively. A 28-year-old woman was admitted to our hospital because of intermittent abdominal pain. Abdominal ultrasonography revealed a large tumor adjacent to the pancreas. Provisional diagnosis made according to computed tomography (CT) findings was tumor of the pancreas tail. However, on a CT scan performed after the administration of diatrizoate meglumine/diatrizoate sodium (Gastrografin, Schering, Berlin, Germany) the mass was shown as a jejunum loop located between the stomach and the pancreas body. Subsequent laparotomy revealed that the jejunum loop was herniated into an unusually large mesocolic fossa and that the hernial orifice was covered by the adhesion between the transverse and descending colons. It seemed that the small intestine within the mesocolic fossa was strangulated by this adhesion. The patient's abdominal pain resolved postoperatively. These observations suggest that paraduodenal hernia should be suspected in patients with chronic, atypical abdominal pain, regardless of the findings for small bowel obstruction.

Inhibition of bFGF activity by complement C1s: covalent binding of C1s with bFGF

The first complement component C1s formed large aggregates with bFGF when bFGF and C1s were incubated at 37 degrees C overnight. Under non-reducing conditions, a part of the aggregates did not penetrate into 5% polyacrylamide gel in the presence of SDS, and the rest penetrated into 5% gel but not into 12% gel. The aggregates were dissociated into monomers by reducing with 2-mercaptoethanol. Both active and inactive C1s formed aggregates with bFGF. In addition, a portion of bFGF was degraded by active C1s but not by inactive C1s. Aggregates were not formed when 2-mercaptoethanol (2 mM) was added to the incubation mixture. After the incubation with C1s the growth-stimulating activity of bFGF was measured by using human umbilical vein endothelial cells (HUVEC) as indicator cells. The aggregate formation between C1s and bFGF significantly reduced the activity of bFGF.

Neutron capture therapy with a new boron-porphyrin compound in the rat 9L glioma model

Neutron capture therapy with a new boron-porphyrin compound was tested in a rat brain tumor model. Although the concentration of boron in the tumor was too low to elicit a therapeutic effect, prominent histopathologic changes, such as necrosis, congestion and bleeding were observed in the tumors of the rats which were administered the boron neutron capture therapy.

Induction of HLA-unrestricted and HLA-class-II-restricted cytotoxic T lymphocytes against MUC-1 from patients with colorectal carcinomas using recombinant MUC-1 vaccinia virus

We recently reported that immunization with a recombinant MUC-1 vaccinia virus (rVMUC-1) protected C57BL/6 mice from challenge with DF3/MUC-1-positive syngeneic tumors. To elucidate whether anti-MUC-1 tumor immunity, especially MUC-1-specific cytotoxic T lymphocytes (CTI), can be induced in cancer patients by rVMUC-1, we stimulated the peripheral blood lymphocytes from patients with DF3/MUC-1+ or DF3/MUC-1 colon carcinomas using the autologous monocytes infected with rVMUC-1 (rVAMN). The stimulated T lymphocytes from two patients with DF3/MUC-1-positive colorectal carcinomas (rVPY+T and rVPW+T) demonstrated HLA-unrestricted cytotoxicity against MUC-1, whereas those from the patient with DF3/MUC-1-negative colon carcinoma (rVPA-T) did not. The HLA-unrestricted cytotoxicity was demonstrated by the CD8+ T cells possibly recognizing an epitope present on the tandem repeats. Adoptive immunotherapy who performed three times with patient PY, at 4-week intervals. The adoptive transfer of the first stimulated lymphocytes, demonstrating a high level of HLA-unrestricted cytotoxicity against MUC-1, resulted in the significant reduction of the liver metastasis of patient PY. However, HLA-unrestricted cytotoxicity against MUC-1 was extremely reduced at the second transfer and finally eliminated at the third, whereas the CD4+ T cells demonstrating HLA-class-II-restricted cytotoxicity against MUC-1 predominantly proliferated at the third adoptive immunotherapy treatment. The liver metastasis and the serum levels of tumor markers (carcinoembryonic antigen CA19-9) demonstrated a rapid and marked increment after the second transfer and especially after the third. These results suggest that the HLA-unrestricted cytotoxic CD8+ T cells against MUC-1, induced in patients with DF3/MUC-1+ colorectal carcinomas using rVMUC-1, correlate with the antitumor activity in vivo.

The angiogenic effect of tissue factor on tumors and wounds

We report a novel function of tissue factor (TF) as an angiogenic factor in malignant and non-malignant cells and tissue. When methylcholanthrene A-induced murine fibrosarcoma (Meth-A sarcoma) was stably transfected with mouse TF (mTF) cDNA (pXT1 expression vector), its vascularization in vivo was significantly enhanced, whereas TF-antisense suppressed the vascularization and tumor growth. In vitro expression of vascular endothelial growth factor (VEGF) was enhanced with stable transfection of mTF (pcDNA3 expression vector) into a mouse fibroblast cell line (NIH3T3). Moreover, in vivo topical transfection of mTF (pcDNA3) showed an enhanced vascularization and healing in a diabetic mouse wound-healing model. This effect of TF as an angiogenic factor might be useful as an antitumor therapy against hypervascular tumors or as a novel agent against delayed wound healing.

Atherosclerosis: coagulation and fibrinolysis

Tissue factor (TF) protein was overexpressed by macrophages and smooth muscle cells (SMCs) and deposited in the extracellular matrix of atherosclerotic intimas, probably resulting in enhanced procoagulant activity and the intimate participation in either thrombus formation or intimal fibrin deposition after the exposure of flowing blood and permeated fibrinogen to TF in atherosclerotic lesions. On the other hand, APO(a) was localized both in the stroma and within some macrophages. Fibrin deposition, which was more frequently detected in the matrix of advanced lesions than in that of early lesions, occasionally colocated with cell- and matrix-associated TF and APO(a) deposited in the matrix. These findings further support the hypothesis that the coagulation and fibrinolysis systems can play an essential role in the initiation and progression of atherosclerosis through fibrin deposition both in atherosclerotic plaques and on the arterial surface by neointimal hypercoagulability and a hypofibrinolytic state, which can also participate in SMC proliferation due to the decreased activation of TGF-beta by embedded and deposited APO(a). The clinical implications of these phenomena may thus contribute to future investigations in the prevention and treatment of atherosclerotic diseases.

Loss of SDF-1 receptor expression during positive selection in the thymus

SDF-1 is a member of the CXC chemokines. In contrast to other chemokines that are induced by inflammation, SDF-1 is constitutively produced by stromal cells. In order to investigate the physiological roles of SDF-1, we constructed a fusion protein, SDF-1-Cgamma1, composed from murine SDF-1alpha and the constant region of human IgG. SDF-1-Cgamma1 stained EL-4 T lymphoma cells and the staining was blocked by rhSDF-1beta. The expression levels of SDF-1R altered along with the T cell maturation. Most c-kit+ hematopoietic precursors in fetal liver in gestational day (GD) 14.5 embryo were SDF-1R-, while c-kit+ double-negative (DN) thymocytes in the embryo were positive for SDF-1R. The receptor expression increased along with T cell maturation up to double-positive (DP) cell stage. Interestingly, SDF-1R expression was down-modulated after positive selection; CD69+CD3hi DP and CD3hi single-positive thymocytes were SDF-1R-/lo. Northern blot analysis demonstrated that SDF-1 and CXCR4 mRNAs were abundantly expressed in the thymuses of embryo and adult mice. These results demonstrate that SDF-1R expression is involved in T cell development in the thymus, particularly in positive selection.

Pancreatic metastasis from a lung cancer. Preoperative diagnosis and management

A case of a surgically resectable solitary metastasis to the pancreas from a lung cancer, confirmed by immunohistochemical staining (PE-10), is reported. ERCP revealed meniscoid interruption of the main pancreatic duct, which is uncommon in patients with primary pancreatic cancers of the pancreas in our hospital. This patient lived for 29 mo after the surgical resection of the pancreatic lesion. Therefore when metastasis limited to the pancreas is evident on clinical imaging, surgical management may be more optimal than other treatment approaches.

Merkel cell carcinoma, Bowen's disease and chronic occupational arsenic poisoning

We diagnosed a unique case of Merkel cell carcinoma (MCC) coexisting with Bowen's disease on the sole of the foot of a 72-year-old man who had worked for about 4 years in a factory handling inorganic arsenic. He had a past history of arsenical keratosis and multiple Bowen's disease. The tumour first appeared as a reddish macule and then showed marked growth over the next month. The tumour was excised and the specimen was examined histopathologically. The tumour consisted of two components: a group of atypical cells representing Bowen's disease in the epidermis and another group of atypical cells with a trabecular pattern characteristic of MCC in the dermis. Neither group of cells showed transitional findings, and the tumour elements were divided by a clear basement membrane. The tumour cells in the dermis were positive for neurone-specific enolase, and on electron microscopy had dense core granules in the cytoplasm. Inorganic arsenic can cause various cutaneous neoplasms, but to our knowledge, this is the first report of a case of MCC associated with Bowen's disease.

Glucose intolerance and adenomas of the sigmoid colon in Japanese men (Japan)

OBJECTIVES

The purpose was to investigate the relation between glucose tolerance and risk of sigmoid colon adenomas, a well-established precancerous lesion, in Japanese men.

METHODS

In the consecutive series of 7,637 men aged 48 to 59 years who received a preretirement health examination at four hospitals of the Self Defense Forces (SDF) in Japan from 1986 to 1994, we identified 821 cases of sigmoid colon adenomas and 4,372 controls with normal sigmoidoscopy or colonoscopy at 60 cm or more from the anus. Glucose tolerance status was classified as normal, impaired glucose tolerance (IGT), newly diagnosed non-insulin dependent diabetes mellitus (NIDDM), or diabetes mellitus under treatment, based on a 75g oral glucose tolerance test and medical history. Statistical adjustment was made for body mass index (wt/ht2), cigarette smoking, alcohol use, rank of the SDF, and hospital.

RESULTS

Modest increases in adenoma risk were observed for newly diagnosed NIDDM and diabetes mellitus under treatment while there was no association between IGT and adenoma risk. When small (< 5 mm in diameter) and large (5+ mm) adenomas were analyzed separately, increased risk associated with newly diagnosed NIDDM was more pronounced for small adenomas, and diabetes mellitus under treatment showed a slightly stronger association with large adenomas.

CONCLUSIONS

The findings suggest that NIDDM is associated with modestly increased risk of sigmoid colon adenomas, and add to evidence that hyperinsulinemia increases colon cancer risk.

Intrathymic selection of NK1.1(+)alpha/beta T cell antigen receptor (TCR)+ cells in transgenic mice bearing TCR specific for chicken ovalbumin and restricted to I-Ad

Generation and negative selection of NK1.1(+)alpha/beta T cell receptor (TCR)+ thymocytes were analyzed using TCR-transgenic (B10. D2 x DO10)F1 and (C57BL/6 x DO10)F1 mice and Rag-1(-/-)/DO10 mice, which had been established by breeding and backcrossing between Rag-1(-/-) and DO10 mice. Almost all T cells from these mice were shown to bear Valpha13/Vbeta8.2 that is specific for chicken ovalbumin (cOVA) and restricted to I-Ad. A normal proportion of the NK1.1(+) Valpha13/Vbeta8.2(+) thymocytes was generated in these mice. However, the actual cell number of both NK1.1(+) and NK1.1(-) thymocytes in I-Ad/d mice (positive selecting background) was larger than that in I-Ab/d mice (negative selecting background). Markedly low but significant proportions of NK1.1(+) Valpha13/Vbeta8.2(+) cells were detected in the spleens from I-Ad/d and I-Ab/d mice. It was shown that the splenic NK1.1(+) T cells of the I-Ab/d mice were anergized against stimulation through TCR. When (B10.D2 x DO10)F1 and (C57BL/6 x DO10)F1 mice were given cOVA, extensive or intermediate elimination of NK1.1(+)alpha/betaTCR+ thymocytes was induced in I-Ad/d or I-Ab/d mice, respectively. However, the clonal elimination was not as complete as that seen in the major NK1.1(-) thymocyte population. The present findings indicate that normal generation of NK1.1(+)alpha/betaTCR+ thymocytes occurs in the absence of Valpha14-Jalpha281 and that substantial negative selection operates on the NK1.1(+)alpha/betaTCR+ cells.

Simple and Patlak models for myocardial blood flow measurements with nitrogen-13-ammonia and PET in humans

The Simple and Patlak models for estimating myocardial blood flow with 13N-ammonia have become attractive for clinical applications with PET because of their simplicity and ease of implementation. However, these models are sensitive to factors such as the data acquisition times and data integration times, which can cause errors in the estimation of myocardial blood flow, as demonstrated in this study. Limiting the application of these models to specific conditions can minimize the errors.

METHODS

Dynamic PET images of the uptake of 13N-ammonia in the heart were obtained in seven humans under rest and dipyridamole stress. Myocardial blood flow was estimated using the Simple and Patlak models for different data acquisition times and data integration times. Blood flow values were compared to flow values computed with the two-compartment model as a reference.

RESULTS

Blood flow values calculated with the Simple and Patlak models during the first 2 min of data acquisition were closely correlated to the two-compartment model values. Longer acquisition times resulted in significant underestimation of blood flow for the Simple model. Long integration times of greater than 60 sec also resulted in significant underestimation of blood flow for both models.

CONCLUSION

The Simple and Patlak models produce estimates of myocardial blood flow that are well correlated with the two-compartment model estimated blood flows for the integration time of 60 sec from 60 to 120 sec postinjection. Because of the errors associated with longer data acquisition times and longer integration times, use of these models should be limited to a well-documented data acquisition paradigm.

[Surgical management for preserving motor function in patients with gliomas near the primary motor cortex: usefulness of preoperative identification of motor cortex and intraoperative monitoring of motor evoked potentials]

Preoperative identification of precentral gyrus and intraoperative monitoring of motor evoked potentials (MEPs) were performed to preserve postoperative motor function in seven patients with gliomas near the primary motor cortex. Tumors were astrocytomas in 3 patients, glioblastomas in 2 patients, anaplastic astrocytoma and mixed glioma in one patient each. Preoperative identification of the primary motor cortex was performed by three-dimensional (3D) display of magnetic resonance (MR) images and by functional images using MR imaging and single-photon emission tomography. The primary motor cortex identified by 3D display of MR images coincided well with that identified by functional images. 3D display of MR images was also useful for detecting the relationship between the tumor and the primary motor cortex. Intraoperatively, the central sulcus was confirmed by the finding of phase reversal of cortical somatosensory evoked potential, and this corresponded with the preoperative identifications by 3D display and by functional mapping. The primary motor cortex was stimulated electrically, and MEP (corticospinal evoked potential) was continuously monitored during surgery using electrodes inserted in the cervical epidural space. The amplitude of direct waves of MEPs during surgery was maintained above half of that recorded at the beginning of tumor removal, and all patients showed preservation of preoperative motor function. These results suggest that preoperative identification of precentral gyrus and intraoperative MEP monitoring provide useful information for preserving motor function in patients with gliomas near the primary motor cortex.

A phase II trial of combination of CPT-11 and cisplatin for advanced non-small-cell lung cancer. CPT-11 Lung Cancer Study Group

A phase I trial of the combination of irinotecan (CPT-11) with cisplatin in advanced non-small cell lung cancer (NSCLC) showed a very promising response rate of 54% in previously untreated NSCLC patients. This study was conducted to confirm the activity and toxicities of CPT-11 and cisplatin combination for previously untreated NSCLC in a multi-institutional phase II study. Seventy patients with stage IIIB or IV NSCLC received CPT-11 60 mg m(-2) intravenously (i.v.) on days 1, 8 and 15, and cisplatin 80 mg m(-2) (i.v.) on day 1 every 4 weeks. Assessments were made of response, survival and toxicities. Sixty-nine were eligible, and evaluable for toxicities and survival, and 64 patients evaluable for response. Thirty-three patients (52%; 95% confidence interval 39-64%) achieved an objective response, with one complete response (2%) and 32 partial responses (50%). The median duration of response was 19 weeks and the overall median survival time was 44 weeks. The 1-year survival rate was 33%. The major toxic effects were leucopenia and diarrhoea. Grade 3 or 4 leucopenia, neutropenia, and diarrhoea occurred in 32 patients (46%), 53 patients (80%), and 13 patients (19%) respectively. A combination of CPT-11 and cisplatin is very effective against non-small-cell lung cancer with acceptable toxicities.

Clinical usefulness of the management and delivery of radiation dose-distribution images using the Internet

Dose distribution images in radiation therapy play important roles in the management of cancer patients. To date, hard copies of these images have been stored for referral by radiation oncologists as needed. In most cases, these images are not available to medical personnel outside the radiation oncology department. We have developed a means to access these dose distribution images from the hospital via the World-Wide Web (WWW). A screen snapshot of a dose distribution image on the CRT of a treatment planning unit is copied to the WWW server and converted to a GIF (graphic interchange format) image. Similarly, we can register dose volume histograms and digitally reconstructed radiographs (DRR) on the WWW. Medical personnel can view these images through the WWW browser from anywhere in the hospital. As a result, radiation oncologists are given detailed information on target definition in treatment planning by expert physicians. The system also helps co-medical personnel in understanding dose distribution and predicting radiation injury. At the same time, it actualizes an electronic archive of dose distribution images, which is a database for quick and reliable review, evaluation, and comparison of treatment plans. This technique also fosters closer relationships among radiation oncologists, physicians, and co-medical personnel.

The ultrastructural findings of Charcot-Leyden crystals in stroma of mastocytoma

Charcot-Leyden crystals (CLCs) have been found in many conditions associated with eosinophilia, but their occurrence in skin diseases is very rare. We report ultrastructural observations on the presence of CLCs in the cutaneous lesions of two cases of mastocytoma. Electron microscopy documented CLCs located in phagosomes of morphologically activated macrophages as well as free CLCs in the stromal tissue, close association between CLCs formation and damaged and lysed eosinophils was present. These findings provided evidence that the formation of CLCs in mastocytoma implicated the individual and interrelated biology of mast cells, eosinophils and macrophages. Phagosomes probably acted as the site of CLCs formation. The clinic and pathologic role of CLCs in mastocytoma deserves further investigation.

The relationship between stapling doughnuts: characteristics and functional results after total gastrectomy

BACKGROUND/AIMS

The objective of this study was to determine whether the thickness of the esophageal doughnut is related to postoperative results in total gastrectomy.

METHODOLOGY

Thirty-eight total gastrectomy patients were studied, including 18 who underwent jejunal pouch reconstruction and 20 who did not have pouch reconstruction. We used the Proximate-ILS circular stapler, with purse-string suturing at the cut end of the esophagus performing only the mucosal layer manually in all cases. We divided the esophageal doughnuts after stapling into two groups: Group A: doughnut involving muscle tissue of 0-25% of the esophageal circumference; Group B: doughnut involved muscle tissue of 25-100% of the esophageal circumference. Reflux scores and the scintigraphic reflux index were determined.

RESULTS

No significant difference was found between the two groups in reflux score or scintigraphic reflux index.

CONCLUSIONS

These findings indicate that the degree of postoperative reflux esophagitis was not affected by the amount of the muscular layer included in the esophageal doughnut. Continuity, and not variability of the degree of involved muscle in the esophageal doughnut, is an important factor at the time of stapling.

Case report: orthodontic treatment of dental problems in incontinentia pigmenti

Incontinentia pigmenti is an uncommon genodermatosis that occurs in female infants. The characteristic dental defects are partial anodontia and the presence of some peg-shaped teeth. This report describes a patient with incontinentia pigmenti who exhibited multiple missing teeth in both arches. The patient had malpositioned teeth and decreased occlusal vertical dimension associated with the missing teeth. Orthodontic treatment was required for prosthetic purposes. The dental anomalies of incontinentia pigmenti and the treatment procedure are presented.