Endobronchial hamartoma treated by an Nd-YAG laser: report of a case

Endobronchial hamartomas are only rarely encountered. They cause irreversible lung damage due to bronchial obstruction if not diagnosed early and treated properly. Among the various treatments for this rare disease, a surgical resection remains the most popular. We herein report a case of a 53-year-old man presenting with an endobronchial hamartoma which was successfully excised by laser irradiation via a rigid bronchoscope, along with a review of 113 patients with this disease reported in the literature.

Effect of iodixanol on renal function immediately after abdominal angiography. Clinical comparison with iomeprol and ioxaglate

PURPOSE

To investigate the acute renal effects of three contrast media in a double-blind randomized parallel-group study. The contrast media investigated were: the nonionic dimeric iso-osmolality medium iodixanol; the nonionic monomeric medium iomeprol; and the ionic dimeric medium ioxaglate.

MATERIAL AND METHODS

A total of 30 patients were given the following doses of contrast medium: 10 patients received iodixanol 320 mg I/ml; 10 received iomeprol 300 mg I/ml; and 10 received ioxaglate 320 mg I/ml. The doses were given intra-arterially at routine abdominal angiography and the renal effects of these three contrast media were studied for up to 120 min after injection.

RESULTS

The urinary minute volume increased immediately after angiography but tended to return to baseline values after 120 min; these changes were more pronounced with iomeprol and ioxaglate than with iodixanol. Creatinine clearance was not reduced by any of the contrast media. Fraction excretion of sodium increased immediately and lasted for 30 min after angiography; these changes were more pronounced with ioxaglate than with iomeprol and iodixanol. Urinary gamma-glutamyl transferase increased for 120 min after angiography with iodixanol and iomeprol; these changes were more pronounced with iomeprol than with iodixanol. On the other hand, urinary nu-acetyl-beta-glucosaminidase increased for 120 min after angiography with iomeprol, but was unchanged with iodixanol.

CONCLUSION

The use of contrast media induces osmotic diuresis and its acute effects on the proximal tubular function. However, the iso-osmolality medium iodixanol induces fewer changes than the other two media.

Distal pancreatectomy--does it have a role for pancreatic body and tail cancer

BACKGROUND/AIMS

Pancreatic resection is the only hope for clinical improvement for patients with carcinoma of the body and tail of the pancreas. However, it is unclear whether palliative pancreatic resection is effective or not for patients with carcinoma of the body and tail of the pancreas.

METHODOLOGY

To determine the appropriate treatment for patients with pancreatic body and tail cancer, we analyzed the records of 74 patients with ductal carcinoma of the body or tail of the pancreas who were treated at Kanazawa University Hospital between 1970 and 1995.

RESULTS

Using a multivariate Cox proportional-hazard model (factors: age, sex, chemotherapy, radiotherapy, hepatic metastasis, peritoneal dissemination, operative procedure), the presence of hepatic metastasis, peritoneal dissemination, and the type of operative procedures (resection or not) were found to be significant prognostic factors. Surgical resection was the most important prognostic factor. The patients with surgical resection had a significantly higher survival rate than those without resection (p < 0.0001). The survival rate of the patients with palliative resections was also significantly higher than that of the patients without resection, except for the patients with advanced liver metastasis (H3). The survival rate of the patients with palliative resections was also higher than that of the patients without resection, even in patients with peritoneal dissemination.

CONCLUSIONS

Surgical resection prolongs the average survival for patients with carcinoma of the body and tail of the pancreas, except for the patients with multiple liver metastasis. These data support the role of palliative pancreatectomy in patients with carcinoma of the body and tail pancreas.

Mesenteric schwannoma

Schwannoma is a benign neurogenic tumor arising from the sheath of peripheral nerves. It occurs very rarely in the mesentery, where it is difficult to diagnose. Herein we describe a case in which contrast-enhanced CT and gadolinium-DTPA-enhanced MR showed a locally enhanced well-defined tumor with a cystic component just anterior to the duodenum. These findings corresponded well to the resected specimen.

Cationic trypsinogen produced by human pancreatic ductal cancer has the characteristics of spontaneous activation and gelatinolytic activity in the presence of proton

We examined whether human pancreatic ductal cancer cells express and secrete pancreatic cationic trypsinogen in vitro which can be spontaneously converted into active trypsin at acidic pH (pH 4.5-5. 5), in contrast to anionic trypsinogen. Cationic trypsinogen expression at the mRNA level was observed in differentiated Capan-1 and BxPC-3 cell lines. However, expression was not detected in either poorly-differentiated Panc-1 or undifferentiated MIAPaCa-2 cell line. The gelatinolytic activity of the activated form of trypsinogen in each conditioned medium in the presence of enterokinase (1.0 microg/ml) (a band with a molecular weight of approximately 23 kDa) corresponded well to the level of cationic trypsinogen mRNA. The spontaneous activation of trypsinogen also was observed by gelatin zymography of the acid-loaded conditioned medium (pH 5.5). These findings suggest that trypsinogen produced by human pancreatic ductal cancer has the characteristics of spontaneous activation and gelatinolytic activity in the presence of proton.

Acute traumatic injury of the distal descending aorta associated with thoracic spine injury

A rare case of traumatic injury of the distal descending aorta associated with thoracic spine injury is reported. A 21-year-old man was admitted after a traffic accident. Thoracic CT and angiography demonstrated a false aneurysm of the distal descending aorta and a compression fracture of the eleventh thoracic vertebra. At emergency surgery, a transverse linear tear at the level of the aortic hiatus was confirmed and repaired.

Effects of synthetic hydroxy isothiocyanates on microbial systems

Hydroxy isothiocyanates (ITCs), including some new derivatives of naturally occurring compounds, were synthesized and their minimum inhibitory, minimum fungicidal, and minimum bactericidal concentrations for Aspergillus niger, Aspergillus fumigatus, Staphylococcus aureus, and Escherichia coli were estimated. These compounds were strongly antimicrobial; for example, 2-(4-hydroxyphenyl) ethyl ITC inhibited growth of all strains examined at concentrations of 7.8 to 15.6 micrograms/ml. The ATP concentration in E. coli was markedly reduced when cells were treated with 2-(4-hydroxyphenyl)ethyl ITC. Inhibition of the growth of E. coli by 2-(4-hydroxyphenyl)ethyl ITC was decreased in the presence of cysteine. Streptolysin S production in washed cells of Streptococcus equisimilis was extremely sensitive to this ITC derivative and this inhibition also was counteracted by cysteine. The results showed that the ITC compounds had antimicrobial effects by blocking sulfhydryl groups.

Induction of human thioredoxin in cultured human retinal pigment epithelial cells through cyclic AMP-dependent pathway; involvement in the cytoprotective activity of prostaglandin E1

Human thioredoxin is one of the oxidative stress-inducible proteins and has a protective function against oxidant-induced injury. To evaluate the possible involvement of thioredoxin in the cytoprotective function of prostaglandin E1, we analysed the effect of prostaglandin E1 on cellular injury by hydrogen peroxide and intracellular thioredoxin induction. Cellular survival of human retinal pigment epithelial cell line, established from normal retinal pigment epithelial cells, following exposure to hydrogen peroxide was markedly improved by pretreatment of 1 microm prostaglandin E1. Thioredoxin expression was augmented in a dose-dependent manner when retinal pigment epithelial cells were pretreated with 10 nm-1 microm prostaglandin E1 1 hr before the exposure to hydrogen peroxide. Intracellular cyclic AMP level was elevated by Prostaglandin E1 when the cells were simultaneously exposed to hydrogen peroxide. Forskolin, an activator of adenylate cyclase, and dibutylyl cAMP, a cyclic AMP analog, could also induce thioredoxin and extend survival of retinal pigment epithelial cells. On the other hand, thioredoxin induction and cellular protection by prostaglandin E1 was blocked by Rp diastereoisomer of cyclic adenosine 3', 5', monophosphorothioate, a competitive inhibitor of cyclic AMP dependent protein kinase. Thioredoxin induction was augmented significantly by pretreatment with prostaglandin I2, a stimulator of cyclic AMP dependent signal pathway, while treatment with prostaglandin F2alpha, a stimulator of inositol phosphate-dependent signal pathway, failed to enhance thioredoxin. These findings indicate that prostaglandin E1 has a cytoprotective activity against oxidative injury, partly through thioredoxin induction via cyclic AMP dependent pathway.

[Clinical assessment of rotational digital angiography for the diagnosis of hepatocellular carcinoma]

PURPOSE

The purpose of the present study was to investigate whether rotational digital angiography add new diagnostic informations concerning the localization and feeding artery of hepatocellular carcinoma.

MATERIALS AND METHODS

Rotational digital angiography was performed in 100 patients with hepatocellular carcinoma. There are 70 males and 30 females, ranging in age from 40 to 81 years. At first, abdominal anterior-posterior digital subtraction angiography was performed in C-arm system using 12/9/7 inch I.I.-TV camera. After that, rotational digital angiography was carried out using SF-VA 100 system in all patients. In the processing of images, the pulse modes were taken during 360 degrees transverse rotation of the X-ray system at a speed of 4.8 sec. The pictures were displayed in real time on a CRT screen with high resolution, and 3 D images were observed.

RESULTS

New diagnostic informations concerning the localization and the feeding artery of the tumor were added in 20 patients using this rotational digital system. The tumors in segment 7/8 (n = 10) were clearly visualized by -90.0 degrees and 90.0 degrees to 135.0 degrees, while tumors in segment 4 (n = 5) were revealed by -45.0 degrees, 49.0 degrees and 60.0 degrees. On the basis of this information, segmental transcatheter arterial embolization could be performed.

CONCLUSION

The device has, therefore, been found to be of great value in diagnosing hepatocellular carcinoma, particularly for the feeding artery and the localization of the tumor.

[Diagnostic imaging of "body packers"]

Drug smuggling by intra-abdominal concealment, so called "body packing," has recently increased, even in Japan. Because of fatal drug intoxication and other adverse side effects, it is important to make a radiological diagnosis of body packers as soon as possible. A retrospective analysis of the images of plain abdominal radiography, computed tomography (CT) and ultrasound (US) was performed in twenty-three body packers to evaluate the imaging characteristics of three drugs (cannabis, cocaine and heroin). Cannabis (16 patients) and cocaine (5 patients) packages were demonstrated as well-demarcated rectangular-shaped high-density shadows surrounded by gas halo ("double condom sign") in abdominal plain radiographs and CT. Heroin packages (2 patients) were demonstrated as obscure shadows and were difficult to identify on plain radiographs, because they resembled stool masses. US was performed in one cannabis patient because of the refusal of radiological examination, and packages were demonstrated as round echogenic structures with dorsal echo extinctions. In conclusion, abdominal plain radiography, CT and US represent valuable diagnostic modalities in the assessment of body packers.

Analysis of initial attachment of B cells to endothelial cells under flow conditions

This study examined the adhesive interactions of peripheral blood B cells with TNF-alpha-activated endothelial monolayers, and analyzed the roles of E-selectin, P-selectin, or VCAM-1 molecules expressed on activated HUVEC. B cell interaction occurred on activated HUVEC, but not on resting HUVEC under flow conditions. The majority of peripheral blood B cells expressed P-selectin glycoprotein ligand-1 and alpha4 integrin. However, the expression of cutaneous lymphocyte Ag on B cells was low. Under flow conditions, B cells could bind to P-selectin-coated tubes and VCAM-1-transfected Chinese hamster ovary cells. In contrast, B cells could not bind to E-selectin-coated tubes. Adhesion activity of B cells to P-selectin-coated tubes was weaker than that of T cells. Furthermore, adhesion activity of B cells to VCAM-1-transfected Chinese hamster ovary cells was similar to that of T cells. Treatment of activated HUVEC with anti-VCAM-1 mAb reduced interaction of B cells under flow conditions. However, the treatment of activated HUVEC with anti-P-selectin mAb did not reduce interaction. These data indicated that the interaction of VCAM-1 with alpha4 integrin plays a major role in an initial attachment of B cells to endothelial monolayers under flow conditions.

Analysis of initial attachment of B cells to endothelial cells under flow conditions

This study examined the adhesive interactions of peripheral blood B cells with TNF-alpha-activated endothelial monolayers, and analyzed the roles of E-selectin, P-selectin, or VCAM-1 molecules expressed on activated HUVEC. B cell interaction occurred on activated HUVEC, but not on resting HUVEC under flow conditions. The majority of peripheral blood B cells expressed P-selectin glycoprotein ligand-1 and alpha4 integrin. However, the expression of cutaneous lymphocyte Ag on B cells was low. Under flow conditions, B cells could bind to P-selectin-coated tubes and VCAM-1-transfected Chinese hamster ovary cells. In contrast, B cells could not bind to E-selectin-coated tubes. Adhesion activity of B cells to P-selectin-coated tubes was weaker than that of T cells. Furthermore, adhesion activity of B cells to VCAM-1-transfected Chinese hamster ovary cells was similar to that of T cells. Treatment of activated HUVEC with anti-VCAM-1 mAb reduced interaction of B cells under flow conditions. However, the treatment of activated HUVEC with anti-P-selectin mAb did not reduce interaction. These data indicated that the interaction of VCAM-1 with alpha4 integrin plays a major role in an initial attachment of B cells to endothelial monolayers under flow conditions.

Arteriovenous malformation of the gallbladder

Review of the literature shows no reports of vascular malformation of the gallbladder. Herein we report an unusual case of arteriovenous malformation of the gallbladder in a patient with hepatocellular carcinoma. The gallbladder lesion was found incidentally during abdominal angiography for the carcinoma. The angiographic features were specific, comprising dilated and tortuous feeding cystic arteries, a racemose vascular network, and early-filling cystic veins.

Effect of iomeprol on renal function immediately after abdominal angiography

PURPOSE

To investigate the acute renal effects of 2 osmolality levels of iomeprol in a double-blind, randomized, parallel-group study.

MATERIAL AND METHODS

Ten patients received iomeprol 300 mg I/ml, and a further 10 received iomeprol 400 mg I/ml intraarterially at routine abdominal angiography. The mean volume of contrast medium administered was 227.3+/-59.3 ml in the iomeprol 300 group and 221.5+/-30.9 ml in the iomeprol 400 group.

RESULTS

The urinary minute volume increased immediately after angiography, but tended to return to baseline 120 min after the examination. No significant decrease in creatinine clearance occurred; however, the fraction excretion of sodium increased immediately after angiography. The lysosomal enzyme N-acetyl-beta-glucosaminidase and the proximal tubular brush border enzyme gamma-glutamyl transferase increased up to 120 min after the procedure. Free water clearance was negative during each study period. No statistical differences in any parameter were evident between these 2 groups.

CONCLUSION

These results suggest that osmotic diuresis and its acute effect on proximal tubular function are induced by the administration of iomeprol, but that these changes are reversible.

Clinical manifestations of HBsAg and anti-HCV negative chronic liver disease in Nagasaki Prefecture, Japan

The discovery of hepatitis C virus (HCV) has enabled the diagnosis of type C chronic liver disease, which had in the past been diagnosed as part of non-A, non-B chronic liver disease. Although most cases with chronic liver disease are caused by hepatitis B virus (HBV) or HCV infection, there are still cases of non-B, non-C chronic liver disease. Forty patients with chronic liver disease, who were seronegative for hepatitis B surface antigen and antibody to HCV, were followed for a mean period of 72 months. The clinical manifestations in these patients were compared with those reported for type B and type C chronic liver disease. Of the 40 patients, 22 were diagnosed with chronic hepatitis, 14 with liver cirrhosis and 4 with hepatocellular carcinoma (HCC). Twenty-seven (67.5%) patients showed mild alanine aminotransferase activity profiles, and the natural clinical course of most patients showed a slow progression compared with that reported for type B and type C patients. The yearly incidence of HCC was 9.7% in patients with liver cirrhosis and 3.9% in chronic hepatitis. These rates were similar to those in type B or type C patients. This suggests that our population sample contained a number of patients with type B, type C or other etiologic agent(s), because 66.7% of the patients who developed HCC had some evidence of exposure to HBV or HCV. Our results suggest that more detailed and accurate tests for detecting HBV and HCV should be considered before making the diagnosis of non-B, non-C chronic liver disease, and that there is the need to reveal unknown etiologic agent(s).

Transcatheter arterial embolization as treatment for life-threatening maxillofacial injury

A rare case of massive maxillofacial hemorrhage, which was controlled by transcatheter arterial embolization, is reported. A 23-year-old man with massive nasal and oral hemorrhage caused by maxillofacial fracture was admitted. Emergency angiography demonstrated extravasation of contrast material from the posterior superior alveolar artery, which was immediately embolized using gelatin sponge particles. This case shows that transcatheter arterial embolization is useful and effective for the treatment of massive hemorrhage resulting from severe maxillofacial injury.

Marine natural products. XXXVI. Biologically active polyacetylenes, adociacetylenes A, B, C, and D, from an Okinawan Marine sponge of Adocia sp

Adociacetylenes A (1), B (2), C (3), and D (4) were isolated as new polyacetylenes from an Okinawan marine sponge of Adocia sp. Their chemical structures have been elucidated on the bases of their chemical and physicochemical properties. Adociacetylenes A (1), C (3), and D (4) exhibited inhibitory activity in the in vitro endothelial cell-neutrophil leukocyte adhesion assay.