Electron-beam CT angiography for thoracic aortic aneurysm and dissection: application of continuous volume scan and electrocardiographically triggered scan

PURPOSE

To assess the diagnostic value of CT angiography of thoracic aortic aneurysm and dissection with electron-beam CT.

MATERIALS AND METHODS

Electron-beam CT angiography was used for the evaluation of thoracic aortic aneurysm (n = 15), and aortic dissection (n = 15). Continuous volume scan (CVS), permitted by continuous X-ray exposure with table incrementation, was performed in all patients. An additional electrocardiographically triggered scan was obtained in four patients. Three-dimensional surface display and multiplanar reformations were obtained and compared with digital subtraction angiography.

RESULTS

Motion artifacts and the resulting degradation of three-dimensional image quality were frequent in the ascending aorta of CVS images. Electrocardiographically triggered sections improved the image quality of the ascending aorta. In the aortic arch and descending aorta, excellent three-dimensional images competitive in quality with digital subtraction angiography were obtained in all patients. For patients with aortic dissection, multiplanar reformation was useful to demonstrate the intimal flap and entry sites.

CONCLUSION

The use of electron-beam CT angiography is feasible for the diagnosis of thoracic aortic aneurysm and dissection.

[Endometrioid adenocarcinoma of the prostate: a case report]

A 69-year-old man was referred to our department with gross hematuria. Magnetic resonance imaging revealed the tumor directly invading the rectum. Biopsy of the tumor by transurethral resection demonstrated endometrioid adenocarcinoma of the prostate. Serum prostate specific antigen (PSA) level was normal. Because the tumor did not respond to hormonal therapy for a month, radical prostatectomy combined with rectal amputation was performed. Immunohistochemically, carcinoembryonic antigen was detected but PSA and prostatic acid phosphatase were not.

Psychological stress induced by 20 days bed rest

We investigated the changes of the psychological state during 20 days bed rest (BR) in 10 young participants,(5 males and 5 females, age; 19-24 yrs). Psychological assessment was accomplished by the following authorized 3 indices: 1) Zung's Self-rating Depression Scale, 2) Cornell Medical Index, and 3) Goldberg's General Health Questionnaire. Zung's Self-rating Depression Scale is a indicator for depression, and the other two indices were used for detecting signs of neurosis. The results from Zung's Self-rating Depression Scale and the General Health Questionnaire in this study indicated a tendency toward depression and neurosis developing during BR, respectively. The scores in the Cornell Medical Index did not change. Urinary excretion of 17-hydroxycorticosteroid increased significantly, indicating that BR immobilization induced an important psychological stress. We were unable to determine which factors caused the changes in psychological state during BR, immobilization insert or personal problems.

Effect of bed rest immobilization on metabolic turnover of bone and bone mineral density

Immobilization induces abnormal bone metabolism and severe decalcification of bone. To investigate the effect of middle-term immobilization on bone metabolism, we studied 10 young healthy males and females during bed rest for 20 days. Bone mineral density (BMD) rapidly decreased in both lumbar and metacarpal bones. No bone showed consistent BMD alterations, partial increase and partial decrease, and both lumbar and metacarpal bone showed similar rapid BMD change. Urinary excretion of pyridinoline tended to slightly increase by day 10, and to decline by day 20 (mean +/-SE: 34.2 +/-7.4, 26.3+/-4.6 nmol day-1, respectively). Neither alkaline phosphatase (isoform III) nor tartrate-resistant acid phosphatase, changed, suggesting that in the early stage of immobilization bone matrix in some part might increase or be resorbed without any activation of osteoblast or osteoclast, resulting in rapid calcification or decalcification, respectively.

Developmental stage-specific and nitrate-independent regulation of nitrate reductase gene expression in rapeseed

cDNA clones for two isogenes of nitrate reductase (NR) have been isolated from rapeseed (Brassica napus L.) androgenetic haploid embryos induced by microspore culture. NR mRNA accumulation can be detected by northern hybridization at 14 d after culture initiation when embryos develop to the heart/torpedo-shaped stage. Whole-mount in situ hybridization experiments demonstrate that the mRNA accumulation is developmental stage specific. In addition, even when cultured in media containing no nitrate, embryos accumulated NR mRNA to almost the same level as the control. This indicates the unique regulation of NR in embryogenesis in which NR mRNA transcription is activated in a developmental stage-specific manner that is independent of nitrate induction. In zygotic embryogenesis, a stage-specific accumulation of NR mRNA was also observed. By contrast, the obvious effect of nitrate on NR expression that has been reported in many plant species was also confirmed in rapeseed leaf. Quantitative combined reverse transcription-polymerase chain reaction analysis suggests that the flexible and variable regulation of NR expression, which is organ specific, nitrogen metabolite specific, and developmental stage specific, is caused principally by regulation of one major structural gene.

Significant mercury deposits in internal organs following the removal of dental amalgam, & development of pre-cancer on the gingiva and the sides of the tongue and their represented organs as a result of inadvertent exposure to strong curing light (used to solidify synthetic dental filling material) & effective treatment: a clinical case report, along with organ representation areas for each tooth

Because of the reduced effectiveness of antibiotics against bacteria (e.g. Chlamydia trachomatis, alpha-Streptococcus, Borrelia burgdorferi, etc.) and viruses (e.g. Herpes Family Viruses) in the presence of mercury, as well as the fact that the 1st author has found that mercury exists in cancer and pre-cancer cell nuclei, the presence of dental amalgam (which contains about 50% mercury) in the human mouth is considered to be a potential hazard for the individual's health. In order to solve this problem, 3 amalgam fillings were removed from the teeth of the subject of this case study. In order to fill the newly created empty spaces in the teeth where the amalgams had formerly existed, a synthetic dental-filling substance was introduced and to solidify the synthetic substance, curing light (wavelength range reportedly between 400-520 nm) was radiated onto the substance in order to accelerate the solidifying process by photo-polymerization. In spite of considerable care not to inhale mercury vapor or swallow minute particles of dental amalgam during the process of removing it by drilling, mercury entered the body of the subject. Precautions such as the use of a rubber dam and strong air suction, as well as frequent water suctioning and washing of the mouth were insufficient. Significant deposits of mercury, previously non-existent, were found in the lungs, kidneys, endocrine organs, liver, and heart with abnormal low-voltage ECGs (similar to those recorded 1-3 weeks after i.v. injection of radioisotope Thallium-201 for Cardiac SPECT) in all the limb leads and V1 (but almost normal ECGs in the precordial leads V2-V6) the day after the procedures were performed. Enhanced mercury evaporation by increased temperature and microscopic amalgam particles created by drilling may have contributed to mercury entering the lungs and G.I. system and then the blood circulation, creating abnormal deposits of mercury in the organs named above. Such mercury contamination may then contribute to intractable infections or pre-cancer. However, these mercury deposits, which commonly occur in such cases, were successfully eliminated by the oral intake of 100 mg tablet of Chinese parsley (Cilantro) 4 times a day (for average weight adults) with a number of drug-uptake enhancement methods developed by the 1st author, including different stimulation methods on the accurate organ representation areas of the hands (which have been mapped using the Bi-Digital O-Ring Test), without injections of chelating agents. Ingestion of Chinese parsley, accompanied by drug-uptake enhancement methods, was initiated before the amalgam removal procedure and continued for about 2 to 3 weeks afterwards, and ECGs became almost normal. During the use of strong bluish curing light to create a photo-polymerization reaction to solidify the synthetic filling material, the adjacent gingiva and the side of the tongue were inadvertently exposed. This exposure to the strong bluish light was found to produce pre-cancerous conditions in the gingiva, the exposed areas of the tongue, as well as in the corresponding organs represented on those areas of the tongue, and abnormally increased enzyme levels in the liver. These abnormalities were also successfully reversed by the oral intake of a mixture of EPA with DHA and Chinese parsley, augmented by one of the non-invasive drug-uptake enhancement methods previously described by the 1st author, repeated 4 times each day for 2 weeks.

[Intratumoral LPD deposition within hepatocellular carcinoma without arterial tumor staining]

The dissociation of intratumoral LPD deposition and arterial tumor staining was investigated in 20 cases of hepatocellular carcinoma (HCC) without arterial tumor staining. The intratumoral deposition of LPD injected from the hepatic artery was observed in nine cases of HCC and coincided with the decrease in tumor vascular bed evaluated by photomicroscopic study and arterial portography. LPD deposition was not observed within the 11 other tumors, which were diagnosed as well differentiated HCC. Infusion angiographic CT revealed that the arterial and portal vascular beds were separated from each other. Therefore, arterial tumor staining was insufficient for accurate evaluation of the tumor vascular bed. The vascular bed in cancerous and noncancerous tissue was accurately evaluated by the addition of the contrast enhancements from the hepatic artery and the portal vein.

Anatomic comparison of the ipsilateral and the contralateral testis in intravaginal torsion

Sixteen cases of intravaginal testicular torsion were studied to compare the intrascrotal anatomy with that of the contralateral testis and to determine possible anatomic predisposition to testicular torsion. The anatomy of the contralateral testis was not always similar to that of the ipsilateral testis, and four of the contralateral testes were judged to be without risk of torsion.

Evaluation of serum tumor markers in patients with advanced or recurrent breast cancer

Serum CA15-3, CEA, and BCA225 concentrations were determined in 98 patients with advanced or recurrent breast cancer in an attempt to correlate elevation with clinical status. The rate of serum positivity was 68.4% (67/98), 55.1% (54/98), and 43.9% (43/98) for CA15-3, CEA, and BCA225, respectively. After a 4 weeks-interval, a 20% change of tumor marker concentration from the preceding assay correlated significantly with clinical findings. Significant elevation was predictive of new recurrence or tumor regrowth after complete remission, especially in patients with bone metastasis. The 20% change in concentration at 4 weeks was also useful in patients with tumor marker concentrations persistently beneath the cut-off level for positive. Serological evaluation of tumor markers in patients with advanced or recurrent breast cancer should seek to document 20% changes over a 4 week interval.

[A case of multilocular cystic renal cell carcinoma treated by partial nephrectomy associated with adrenal tumor]

A case of multilocular cystic renal cell carcinoma was reported. The patient was 69-year-old male who had been examined for postoperative study of gastric cancer by abdominal CT. The abdominal CT incidentally revealed right adrenal tumor which was non-functional and multilocular cysts in the lower pole of the right kidney. Selective renal arteriography showed a hypovascular mass with fine neovascularity. These two findings of CT and arteriography were though to represent a probable malignant tumor but renal function of the patient decreased moderately. Surgical exploration was done and right renal masses were thought to be seen benign multilocular cysts without capsule. Simple excision of the wall of cysts and right adrenalectomy were performed. Pathological examinations showed multilocular cystic renal cell carcinoma and benign adrenal hyperplasia. Additionally partial nephrectomy was done. Surgical margin of the kidney was tumor free and postoperative course was uneventful. Prognosis of multiocular cystic renal cell carcinoma is good, therefore conservative surgery is recommended.

Molecular changes of organelle DNA sequences in rice through dedifferentiation, long-term culture, or the morphogenesis process

Callus-specific rearranged DNA in rice (Oryza sativa L.) was isolated by in-gel reassociation procedure. Southern hybridization experiments revealed that some clones were amplified significantly in primary callus induced from scutellum tissue. Rapid amplification of these clones was observed within 2 days after plating seeds onto callus-induction medium containing 2,4-D. NAA gave no significant effect on DNA amplification event. Colony formation process from isolated protoplasts and plant regeneration process from callus showed clone-specific and process-specific fluctuation patterns of copy number. Sequence analysis of the clones suggested that most of the clones were originated from organelle DNA. Comparison of copy number fluctuation pattern of organelle functional genes with that of the clones suggested multiformity and/or construction-specific amplification of organelle DNA.

Cutaneous hyperalgesia induced by peripheral injection of interleukin-1 beta in the rat

The contribution of the activity of afferent fiber filaments to pain and hyperalgesia after administration of a plantar injection of interleukin-1 beta (IL-1 beta) to the hind-paw skin was investigated by recording action potentials of the rat dorsal root in response to mechanical and thermal stimuli. Touch stimuli were delivered by stroking with a cotton-tipped applicator and thermal stimulation was applied by cooling or heating of the skin. After the administration of IL-1 beta (100 pg-1 microgram), responses to touch, cold, and heat stimulation increased to 143%, 200%, and 392%, respectively, of control values on average. IL-1 beta induced transient spontaneous discharge in 50% of experiments. The effects of IL-1 beta were apparent within 1 min. To examine responses to pressure stimulation, an area of 1 mm2 of the hind-paw skin was pressed by a mechanical stimulator. IL-1 beta (0.1 pg-200 ng) decreased the threshold value to 58% of the control pressure required for firing. IL-1 beta also increased responses to various levels of pressure (range: 1-20 g/mm2). These data suggest that IL-1 beta may play an important role in cutaneous hyperalgesia by activating polymodal receptors to mechanical and thermal stimulation.

[Primary transitional cell carcinoma in situ of the renal pelvis: a case report]

A 71-year-old female presented with left back pain at our hospital. She had had the same symptom about 1 year previously, but she had been presumed to have undergone stone passage because her symptom had disappeared. At this time a urogram, either excretory or retrograde, showed narrowing of each caliceal infundibulum and dilatation of each calyx in the left kidney, but otherwise normal findings. A cytology of left ureteral urine was class V, and cystoscopy revealed no abnormality. Under the diagnosis of left renal pelvic tumor she underwent nephroureterectomy with resection of a bladder cuff and retroperitoneal lymphadenectomy. The resected specimen had no gross tumor throughout the renal pelvis and ureter, but histological examination revealed transitional cell carcinoma in situ (grade 2) in most of the renal pelvis and infiltration of inflammatory cells in the submucosa. The ureter did not have any cancerous lesion, and no lymph node metastases was found. Four months postoperatively she is thought to have no evidence of disease with negative urinary cytology.

[Estimation of vasopressin treatment in the upper GI bleeding using Doppler flowmetry]

The effect of intravenous vasopressin infusion in 5 patients with upper GI bleeding was studied by measuring portal blood flow velocity with pulsed Doppler ultrasound technique. In 4 of 5 patients portal blood flow velocity decreased at 1 hr after vasopressin infusion. In all patients the velocity decreased at 24 or 48 hrs. We think doppler is safe and useful method in the evaluation of vasopressin infusion therapy.

Transport mechanism of an H1-antagonist at the blood-brain barrier: transport mechanism of mepyramine using the carotid injection technique

The blood-brain barrier (BBB) permeability of mepyramine was measured by the carotid injection technique to elucidate the transport mechanism of an H1-antagonist in the central nervous system. Mepyramine was found to enter the brain by saturable and carrier-mediated transport. The in vivo kinetic parameters were estimated as follows: the maximum uptake rate (Jmax) was 7.12 +/- 1.37 mumol/min/g of brain, the Michaelis constant (Kt) was 4.40 +/- 2.00 mM, and the nonsaturable first order rate (Kd) was 0.28 +/- 0.02 ml/min/g of brain. The mepyramine transport was not inhibited either by nutrients or by choline, hemicholinium-3, though it was inhibited by the classical H1-antagonists such as diphenhydramine, diphenylpyraline, and also by propranolol. The above inhibitory effects suggest that a transport system different from the amine transport system exists for the BBB transport of mepyramine, and that this transporter is common not only for H1-antagonists but also for basic drugs.

Rapid conversion of rDNA intergenic spacer of diploid mutants of rice derived from gamma-ray irradiated tetraploids

The organization of tandemly repeated sequences of ribosomal DNA (rDNA) in rice mutants derived from gamma-irradiated tetraploids was analyzed. Southern hybridization analysis of nuclear DNA revealed that most of the intergenic spacers (IGSs) in mutant rDNA are replaced concertedly by new molecular species. The new IGSs are produced by the amplification of a subrepeat of about 250 bp. Results obtained from sequence analyses indicate that various intermediate molecular species of the subrepeat were formed during structuring of the IGS region and that many rearrangements occurred between them. These findings demonstrate the effectiveness of recurrent irradiation of tetraploids for inducing artificial genome rearrangement, and also indicate the extreme plasticity and variability of genome structure in plants.

[Catheter intervention to venous system using expandable metallic stents]

Superior vena cava syndrome mainly associated with malignant tumors, is usually resistant to any therapy. Although mechanical dilation of narrowed lumen is ideal for relief of symptoms, conventional balloon angioplasty has not been effective method. Surgical intervention is not a good choice in patients with advanced malignant tumors. Recently developed expandable metallic stents have been adopted to superior vena cava syndrome with good results. In this article, characteristics of expandable metallic stents is reviewed, and our experience of expandable metallic stents (Gianturco stent and Wallstent) in venous system is indicated. In addition, percutaneous insertion of inferior vena cava filter (Greenfield filter) is also mentioned.

[Late recurrence of renal cell carcinoma: report of three cases]

A 70-year-old woman underwent a left radical nephrectomy. The pathological examination revealed renal cell carcinoma (RCC), grade 1 and no lymph node metastasis. She suffered a recurrence in the renal fossa 11 years after the operation. The doubling time of the recurrent lesion was calculated to be very long for the cancer; about 1.3 years. Another case was in a 61-year-old woman, who underwent a right radical nephrectomy. The pathological examination revealed RCC, grade 1 with vascular invasion and no lymph node metastasis. Eleven years postoperatively she developed metastases in both lungs. The other case was in a 39-year-old woman, who underwent right radical nephrectomy. The pathological examination revealed RCC, grade 1 with vascular invasion and no lymph node metastasis. Eight years postoperatively she developed a recurrence in the left kidney. The doubling time of the recurrent lesion was about 0.9 year. All three patients responded to conservative therapy including interferon. Taking those doubling times into account, the recurrent lesions in the first and third cases seemed to have been growing very slowly and not rapidly immediately before clinically evident recurrence. Patients with a low grade RCC must have life-long followup.

Metabolic turnover of bone and peripheral monocyte release of cytokines during short-term bed rest

Immobilization induces abnormal bone metabolism and rapid decalcification. Measurements of bone mineral content disclosed rapid decalcification, especially in lumbar vertebral and metacarpal bones in our short-term 20-day bed rest study. Many factors could contribute to the marked demineralization. The activities of osteoclasts and osteoblasts were studied by following serum levels of tartrate-resistant acid phosphatase and alkaline phosphatase, biomarkers for osteocyte activity. There were no alterations in these enzymes during bed rest. However, urinary excretion of pyridinium cross-links, resorption markers of bone matrix itself, increased by day 10 with subsequent decrease at day 20. So decalcification was induced without any relation to osteoclast activity. As cytokines strongly modulate the function of osteoclasts, peripheral monocyte release of interleukin 1 alpha and tumor necrosis factor alpha were assayed to determine the contribution to this rapid demineralization. Cytokines were released transiently by day 7 and later rapidly decreased. However, there was no correlation between cytokine release and bone matrix resorption.

Ethics and fetal medicine

Ethical issues in the clinical practice of fetal medicine are discussed, largely from the point of view of early prenatal medicine. The discussion concentrates on several aspects including the time when human life begins, the pros and cons of fetal medicine, and ethical guidelines for fetal medicine. The emphasis is placed on the importance of informed consent and an increase in genetical knowledge amongst the general public.

[Clinical study of allylestrenol (Perselin) on patients with prostatic hypertrophy]

The efficacy and safety of allylestrenol were studied in 22 patients with benign prostatic hypertrophy. A 25 mg allylestrenol tablet (Perselin tablet) was administered twice a day. A significant decrease in frequency of nocturnal urination was observed and improvement rates of subjective symptoms, such as sensation of residual urine, delay in start of urination, straining during urination and strength of urinary stream, were 59.1-68.2%. The rate of decrease of maximum area of transverse plane of prostate estimated by transrectal sonography was 13.2% and presumed circle area ratio (PCAR) improved significantly. The incidence of total side effects was 22.7%, whereas a decrease in sexual potency was observed in only 4.5% of the cases. The final global improvement rating of allylestrenol was 72.2% and the rate of usefulness was estimated in 63.6% of the patients. The present findings confirmed that allylestrenol is a useful and safe drug for the treatment of benign prostatic hypertrophy.