Plasma thrombin-antithrombin III complex is associated with the severity of experimental autoimmune encephalomyelitis

Previous studies have shown that activation of blood coagulation and fibrin depositions around CNS vessels are observed in animals with experimental autoimmune encephalomyelitis (EAE), which provides an animal model for human autoimmune demyelinating disorders. We examined the values of peripheral blood fibrinogen, thrombin-antithrombin III complex (TAT), fibrinolytic activity, and fibrin degradation products in Lewis rats with EAE to elucidate the role of the blood coagulation-fibrinolysis system in EAE. Plasma TAT values increased immediately prior to development of symptoms, and decreased according to the improvement of symptoms. There was significant correlation between TAT values and clinical scores of EAE; other markers were not correlated with the symptoms of EAE. These results suggest that plasma TAT levels are sensitive markers of the severity of EAE, and may be useful clinical indicators for the severity of human autoimmune demyelinating disorders.

Element concentrations in urine of patients suffering from chronic arsenic poisoning

In order to know the element levels in the urine of patients with chronic arsenic poisoning caused by arsenic assimilated from burning coal via air and food, we investigated various elements in the urine of 16 patients with this disease and 16 controls living in the same county in Guizhou Province of China. Concentrations of 25 elements (Al, As, Ba, Be, Bi, Ca, Cd, Cr, Cu, Fe, Ga, Mg, Mn, Mo, Ni, P, Pb, Rb, Sb, Se, Sn, Sr, Ti, V and Zn) were determined by an inductively coupled plasma mass spectrometer or an inductively coupled plasma atomic emission spectrometer. The average concentrations of Cu, Ga and Sn as well as As in the patients were significantly higher, and those of Cr, Rb, Sr and Ti in the patients were significantly lower than the control values. Al, Ba, Mn, Ni and Se were under detection limit in the patients, though they could be detected in the controls. There were no positive correlations between the concentration of As and the concentrations of other elements, including Cu, Ga and Sn in the patients. The results of this study suggest that As from burning coal might influence the urinary excretion of some elements.

[Specific features of obesity in children and its management]

Obesity during childhood is caused by both congenital and acquired causes. Obese children usually have family history, especially of their mothers. Identical twins have similar weight even if they are reared apart. In very rare cases of heritable obesity, genetic defects in leptin synthesis and its receptor, POMC, MC4 receptor, and prohormone converting enzyme have been reported. In addition, body weight of children and adolescents is related with their life styles, and the prevalence of obesity in recent years is higher than before probably due to changes in calorie intake and energy expenditure. Diagnosis of obesity is based on the assessment of overweight using BMI in most cases of adults. During childhood and adolescence, BMI can not be applied as in adults and its percentile values are useful for children. Percentage of overweight for the standard weight for height has been used as well to demonstrate over- or underweight in children and adolescents. Evaluation of fat volume and its distribution is essential for the precise diagnosis of obesity in children as well as adults.

Pre-operative detection of malignant hepatic tumours: value of combined helical CT during arterial portography and biphasic CT during hepatic arteriography

AIMS

The purpose of our study was to evaluate the observer performance with combined helical CT during arterial portography (CTAP) and biphasic CT hepatic arteriography (CTHA) in the pre-operative detection of malignant hepatic tumours.

METHODS

Computed tomography images obtained in 41 patients with suspected hepatic tumours were retrospectively reviewed. In a blind fashion, three off-site, independent radiologists reviewed CTAP and early-phase CTHA combined for the first review, then late-phase CTHA was added for the second review. Statistical analysis was conducted on lesion-by-lesion and segment-by-segment bases; a total of 328 liver segments including 65 segments with 74 malignant hepatic tumours ranging in size from 5 to 100 mm (mean, 21.4 mm) were analysed.

RESULTS

Sensitivity for detection of liver segments harbouring tumours of CTAP and biphasic CTHA combined (82%) was identical to that of CTAP and early-phase CTHA combined (82%). Specificity of CTAP and biphasic CTHA combined (93%) was greater than that of CTAP and early-phase CTHA combined (90%, P < 0.005). The mean confidence level for the 74 tumours significantly increased by adding late-phase CTHA (P < 0.0005). The mean confidence level for 100-142 benign perfusion abnormalities detected with CTAP and early-phase CTHA combined significantly decreased by adding late-phase CTHA (P < 0.0005).

CONCLUSION

By combining late-phase CTHA with CTAP and early-phase CTHA information, the specificity for the detection of malignant hepatic tumours rises significantly, allowing more accurate preoperative tumour detection.

Biopsy of lung nodules with use of I-I device under intermittent CT fluoroscopic guidance: preliminary clinical study

PURPOSE

To investigate the efficacy of computed tomography (CT) fluoroscopy and a new needle holder (the I-I device) in lung nodule biopsy.

MATERIALS AND METHODS

The I-I device is made of acrylate resin and was used to keep the entire needle in the tomographic plane. This study consisted of biopsies of 79 lung nodules in 77 patients. The final diagnoses were malignant in 54 patients, benign in 23, and unconfirmed in two. The biopsy procedure time from the beginning of the CT fluoroscopy procedure to the removal of the needle was measured for 24 needle passes. The radiation dose on the physician's hand was measured in five cases with use of a thermoluminescence ring.

RESULTS

Fifty-one malignant and 20 benign lesions were correctly diagnosed with histologic specimens (90%). In 58 of 77 patients (75%), the biopsy procedures were completed within a single breath-hold. Pneumothorax occurred in 20 of 77 patients (26%) and chest tube insertion was required in five. The incidence of pneumothorax was significantly lower in patients who held their breath during biopsy procedures compared with those who did not (P < .0001; chi2 test). The biopsy procedure time ranged from 15 to 39 seconds (mean: 28.2 sec). The mean radiation dose on the physician's hand was 2 mSv/case.

CONCLUSION

The diagnostic accuracy of biopsy with use of the I-I device under CT fluoroscopic guidance is comparable with that of the conventional method; however, a combination of CT fluoroscopy and the I-I device enables rapid biopsy procedures.

Helicobacter pylori infection among Japanese children

BACKGROUND

In Japan, there are few reports describing Helicobacter pylori infection among young children. The aim of the present study was to identify risk factors associated with H. pylori in school-aged children.

METHODS

Subjects were first-grade students of three elementary schools (n = 310) and second-grade students of a junior high school (n = 300). Personal information, such as student's medical history, parent's history, family size, sibshipsize and household pets, was collected from guardians using a questionnaire. Saliva samples and personal information were collected twice (1995 and 1996). By using the saliva samples, H. pylori IgG antibody was measured using a commercial kit. To analyze the risk factors for H. pylori infection, sex- and age-adjusted odds ratios (OR) were calculated using a multiple logistic model.

RESULTS

Among the children, factors related to Helicobacter antibody in saliva included spending a longer period of time in a nursery school or kindergarten (OR = 4.0) and a maternal history of stomach disease (OR = 2.8). Birth order (OR = 2.2), sleeping situation (OR = 2.3) and sibshipsize (OR = 1.6) were not factors that were significantly related to Helicobacter antibody in the saliva. Chewing food for the infant, family size, rooms in the household, sharing a bedroom during childhood, pets, a past history and a paternal history were not related to positivity.

CONCLUSIONS

The results indicate that transmission is person-to-person, mainly through close contact with other children and intrafamilial infection. Helicobacter pylori infection seems to occur frequently early in life, probably before 6 years of age.

[Hepatic arterial infusion chemotherapy for liver metastases from colorectal cancer]

After randomized studies of hepatic arterial infusion chemotherapy (HAIC) versus systemic chemotherapy for liver metastases from colorectal cancer in the 1980s, the role of HAIC has been unclear and there is still no evidence to support it as the treatment of choice. The high local control, the differences in techniques between Japan and Western countries, the difficulty of detecting pre-treatment extra-hepatic metastases and the fact that HAIC does not control extra-hepatic lesions are the most important points in considering clinical trials of HAIC. Clinical studies on the combination of HAIC using 5-FU and systemic chemotherapy using CPT-11, and then randomized trial of systemic chemotherapy with/without HAIC is required in Japan to reveal the role of HAIC in the management of liver metastases from colorectal cancer. We should understand the importance of our role in this field.

A cross-sectional study on the relationship between leisure or recreational physical activity and coronary risk factors

Several researchers have investigated the relationship between physical activity and coronary risk factors. Little is known about the strength of the relationship between physical activity and each coronary risk factor. The aim of this study is to determined the strength of the relationship between leisure or recreational physical activity and selected coronary risk factors. The subjects were 781 male Japanese office workers who underwent an annual physical examination in 1999, including interview about the type and frequency of their leisure or recreational physical activities, other lifestyle questionnaire, and biological measurement, calculated a physical activity index (PAI) for each subject. To investigate the strength of the relationship between PAI and each coronary risk factor, we carried out multiple regression analysis. Smoking habit, log triglycerides, self-rating depression scale (SDS) score, alcohol habit and left ventricular hypertrophy were significantly related to the physical activity (partial R2: 0.031, 0.018, 0.016, 0.0092, 0.0075, respectively). Smoking habit was the strongest determinant of the physical activity. Furthermore, we found the inverse relationship between SDS score and physical activity independently.

Mechanism of anti-tumor effect of combination of bleomycin and shock waves

We have previously reported marked enhancement of the cytocidal effect of bleomycin (BLM) on cancer cell suspensions in vitro by the combination with shock waves. In this study, we evaluated the synergistic effects on cancer cell proliferation and apoptosis in solid tumors. A spherical piezo-ceramic element was used as the shock wave source, with a pressure peak of 40 MPa. A human colon cancer cell line, SW480 was implanted onto the back of nude mice. Two thousand shock waves were administered to the tumor immediately following an intravenous injection of BLM at a dose of one-tenth of the LD(50). The tumor was extirpated at 3, 6, 12, 24, 72 h and 1 week following shock exposure. Cell proliferation and apoptosis were detected by Ki-67 using antibody MIB-1 and by the terminal deoxynucleotidyl transferase (TdT)-mediated dUTP-biotin nick-end labeling (TUNEL) method. The lowest percentage (35.7%) of Ki-67-positive cells appeared 24 h following the treatment. The maximum apoptotic index was detected within 6 h following the treatment. Moreover, numerous large cells with enlarged nuclei were detected histologically. These results suggest that shock waves may enhance chemotherapeutic effects by increasing apoptosis and decreasing cell proliferation in the tumor tissue.

Massive intrathoracic haemorrhage after CT-guided lung biopsy

CT-guided lung biopsy is now widely performed for tumorous lesions in the lung, and both its usefulness in this context and the associated complications have been well described in the literature. Although severe complications are rare, we describe a case in which massive intrathoracic haemorrhage developed after lung biopsy and necessitated emergency operation for control. Intraoperative findings suggested that the source of the haemorrhage was a fibrous, cord-like substance present at the site of adhesion associated with old tuberculosis. We attributed this haemorrhage to a pneumothorax, which developed after lung biopsy and caused the new vessels penetrating the centre of the fibrous, cord-like substance to stretch and rupture. Numerous cases have been reported of spontaneous haemopneumothorax precipitated by spontaneous pneumothorax and resulting from the rupture of such vessels.

Increased hepatic arterial blood flow after decreased portal supply to the liver parenchyma owing to intrahepatic portosystemic venous shunt: angiographic demonstration using helical CT

This study was conducted to investigate the haemodynamics of the liver parenchyma in the presence of intrahepatic portosystemic venous shunt. 3 patients with intrahepatic portosystemic venous shunts and 24 patients with normal intrahepatic haemodynamics underwent both CT arterial portography and CT during hepatic arteriography. Angiographic findings with helical CT were compared, and CT attenuated values were measured in both groups. The liver parenchyma on CT arterial portography had lower attenuation than on CT during hepatic arteriography in all patients with intrahepatic portosystemic venous shunts. Overall average CT attenuation was 92.2 +/- 7.7 Hounsfield units (HU) on CT arterial portography and 149.9 +/- 8.5 HU after CT during hepatic arteriography, with the opposite findings in all patients without intrahepatic portosystemic venous shunt: CT attenuation 142.0 +/- 25.7 HU on CT arterial portography and 100.7 +/- 16.4 HU after CT during hepatic arteriography. In conclusion, the portal venous supply to the liver parenchyma decreased due to intrahepatic portosystemic venous shunts, with a compensatory increase in hepatic arterial blood supply.

A high level of physical fitness during thirties is a negative risk factor for colonic polyps during fifties

This case-control study examined the relationship between the occurrence of colonic polyps in men in their fifties and the level of their physical fitness while in their thirties. The subjects consisted of 51 male Japan Self-Defense Forces officials in their fifties who had colonic polyps, as diagnosed by colonoscopic examination, and 46 control individuals. As an indicator of physical fitness between 30 and 39, we selected the best time recorded for each individual during that decade of life for the 1,500 meter Physical Fitness Test run. We calculated the odds ratio for polyps according to selected risk factors (including physical fitness), and a logistic regression analysis was used to adjust for possible confounding variables. Odds ratio (95% confidence interval, p value) for colonic polyps with physical fitness in the thirties was 0.36 (0.16-0.82, p < 0.05). With adjustment for the subjects' maximum Body Mass Index in both their thirties and fifties, and serum total cholesterol, the odds ratio was 0.39 (0.15-0.99, p < 0.05). We suggest that the occurrence of colonic polyps in men in their fifties can be reduced by maintaining a high level of physical fitness while in their thirties.

[Supplementary motor area epilepsy associated with ADHD in an abused history]

A 6-year-old girl with attention-deficit hyperactivity disorder (ADHD) who had been abused by her mother in infancy developed supplementary motor area (SMA) epilepsy. The seizure was characterized by bilateral tonic seizure of the upper and lower extremities, speech arrest, preserved consciousness and a lack of postictal confusion. The duration of the seizure was usually 10-60 seconds. The seizures sometimes clustered. She was diagnosed as having SMA epilepsy based on the characteristic clinical symptoms, interictal EEG, ictal video-EEG and ictal SPECT. Though her seizure was initially improved by anti-epileptic drugs, the symptoms appeared again after discharge. Since her clinical course indicated that her seizure was aggravated by her mental state, treatment included both medication with anti-epileptic drugs and the adjustment of her living environment in cooperation with a child guidance clinic. Thereafter both her epileptic seizure and ADHD symptoms improved. These changes may be related to each other, because both conditions are associated with frontal lobe dysfunction. It was interesting that the adjustment of the environment improved frontal lobe epilepsy, which in turn ameliorated ADHD symptoms.

Effect of age on the relationship between gastric cancer and Helicobacter pylori. Tokyo Research Group of Prevention for Gastric Cancer

Helicobacter pylori is thought to be involved in the pathogenesis of gastric cancer, but the time point at which it produces its effects (critical time) is unknown. We measured the serum level of H. pylori antibody in 787 gastric cancer patients and 1007 controls aged 20 to 69. Odds ratios for different gastric cancer types and stages were determined for each 10-year age class. The overall odds ratio for gastric cancer decreased with age, being 7.0 for those aged 20 - 29, 14.5 for those aged 30 - 39, 9.1 for those aged 40 - 49, 3.5 for those aged 50 - 59, and 1.5 for those aged 60 - 69 (trend in odds ratios: P < 0.01). However, there was no such age-dependent trend for early diffuse-type cancer; the odds ratios were 12.6, 4.0, 7.2, 6.5, and 18.5 respectively (P = 0.29). Early cancer tended to show higher seroprevalence than advanced cancer, especially in older subjects. No significant difference in seroprevalence was observed between diffuse and intestinal cancers within each age-class. Seroreversion must have occurred in the time interval between the critical time and the diagnosis of the cancer, especially in older patients. The age-dependent relationship between H. pylori and gastric cancer may be due to seroreversion, which itself may be independent of age. This age-independence indicates that prolonged exposure to H. pylori does not increase the magnitude of its influence on gastric carcinogenesis. Possible mechanisms through which H. pylori exerts pathogenic effects are continuous inflammation in adulthood and / or irreversible damage to gastric mucosa in childhood or the teenage years.

Mycological examination of the hair samples of 11 school-going Nepalese children suspected of tinea capitis

Among 150 students from a semi-urban school in Kathmandu (Nepal), 30 from various age groups and both sexes with symptoms suggestive of scalp ringworm, were examined clinically. Hair samples were collected for mycological examination, using the hair brush method, from 11 of the 30 children (36.7%), aged between 5 and 14 years, who were clinically diagnosed. Four of the cultured samples were positive for isolates of Trichophyton violaceum. This minor study provides evidence that tinea capitis might constitute a substantial infectious dermatological problem in Nepal. The study also indicated T. violaceum as the causative organism of tinea capitis.

The aetiology of non-tumorous enhancement in the hepatic hilum shown on CT hepatic arteriography

The causes of non-tumorous abnormalities in the hepatic hilum seen on CT hepatic arteriography were investigated. 13 patients with non-tumorous defects of portal perfusion in the hepatic hilum on CT arterial portography underwent both CT hepatic arteriography from the common hepatic artery and CT obtained during proper hepatic arteriography. The findings of non-tumorous portal defects on these two angiographic studies using helical CT were compared. In the 13 patients, 14 non-tumorous defects of portal perfusion in the hepatic hilum on CT arterial portography were detected as enhanced areas in 10 regions (dorsum of segment IV, 7/10; dorsum of the lateral segment, 3/4) on CT hepatic arteriography via the common hepatic artery, but none were enhanced on CT obtained during proper hepatic arteriography. In conclusion, the main cause of non-tumorous enhancement in the hepatic hilum seen on CT hepatic arteriography is non-portal direct inflow via the parabiliary venous system.

Extracorporeal shock wave lithotripsy for a ureteral stone in crossed fused renal ectopia

BACKGROUND

A 63-year-old woman presented with right flank pain and macroscopic hematuria.

RESULTS/METHODS

A plain film showed a calcific shadow on the right iliac bone. On excretory urography, the right kidney was seen in the normal position, but the left kidney was not. Bilateral retrograde pyelogram revealed the S-shaped kidney and mild obstruction from a 12 x 5 mm calculus in the proximal ureter of the crossed kidney. The patient was successfully treated with in situ extracorporeal shock wave lithotripsy (ESWL) treatment and is stone free at 1 month follow up.

CONCLUSION

We believe this is the first case of successful ESWL in a crossed kidney.

Long-term effect of Helicobacter pylori infection on serum pepsinogens

Serum pepsinogen values are markers of gastric mucosal status and of gastric cancer risk. The effect of Helicobacter pylori infection and sibship size on change of serum pepsinogen values over a seven-year span was investigated. Data from 2584 subjects with phlebotomy were analyzed both in 1989 and in 1996. The subjects were classified by H. pylori serology and sibship size (1 - 3 vs. 4 and more). Pepsinogen I (PG I) to II (PG II) ratio in '96 minus that in '89 was defined as DeltaPG I / II and compared among the groups. DeltaPG I / II was lower and decrease of PG I / II was more frequent among H. pylori-positive subjects than among negative subjects. The difference was owing to a decrease of PG I in all subjects and owing to an increase of PG II in those not younger than 30 years in '89. In H. pylori-positive subjects, those with a larger sibship size showed lower DeltaPG I / II and higher frequency of PG I / II decline. H. pylori infection exerts a reducing effect on PG I / II during the seven-year span. The effect of H. pylori is stronger among those with a larger sibship size, who are expected to have been infected with H. pylori in childhood. Inducing atrophy of gastric mucosa, which is reflected by a decline of PG I / II, may be one of the mechanisms through which H. pylori elevates the risk of gastric cancer.

Revealing hepatic metastases from colorectal cancer: value of combined helical CT during arterial portography and CT hepatic arteriography with a unified CT and angiography system

OBJECTIVE

The purpose of our study was to evaluate the use of combined helical CT during arterial portography and CT hepatic arteriography in the preoperative assessment of hepatic metastases from colorectal cancer using a unified CT and angiography system.

MATERIALS AND METHODS

Fifty-four patients with hepatic metastases from colorectal cancer preoperatively underwent combined CT during arterial portography and CT hepatic arteriography using the unified CT and angiography system. Three radiologists independently and retrospectively reviewed the images of CT during arterial portography alone, CT hepatic arteriography alone, and combined CT during arterial portography and CT hepatic arteriography. Image review was conducted on a segment-by-segment basis; a total of 432 hepatic segments with (n = 103) 118 metastatic tumors ranging in size from 2 to 160 mm (mean, 25.8 mm) and without (n = 329) tumor were reviewed.

RESULTS

Relative sensitivity of combined CT during arterial portography and CT hepatic arteriography (87%) was higher than that of CT during arterial portography alone (80%, p < 0.0005) and CT hepatic arteriography alone (83%, p < 0.005). Relative specificity of CT hepatic arteriography alone (95%, p < 0.0005) and combined CT during arterial portography and CT hepatic arteriography (96%, p < 0.0001) was higher than that of CT during arterial portography alone (91%). Diagnostic accuracy, determined by a receiver operating characteristic curve analysis, was greater with combined CT during arterial portography and CT hepatic arteriography than with CT during arterial portography alone (p < 0.05) or CT hepatic arteriography alone (p < 0.01).

CONCLUSION

Using a unified CT and angiography system, we found that combined CT during arterial portography and CT hepatic arteriography significantly raised the detectability of hepatic metastases from colorectal cancer.

Technical aspects of venous stenting in high-grade stenoses using a long guidewire between dual venous access sites

We describe the technical benefits of the dual-access technique for venous stenting in high-grade stenosis. Stents were implanted successfully with this technique in all patients, although the preceding transfemoral interventions had failed. The dual-access technique is useful to facilitate the intervention when the stenoses are too severe to place the stent through just a single access point.

Anti-IL-12 antibody prevents the development and progression of multiple sclerosis-like relapsing--remitting demyelinating disease in NOD mice induced with myelin oligodendrocyte glycoprotein peptide

Treatment with monoclonal anti-IL-12 antibody injected on day 0, 7 and 10 after immunization with myelin oligodendrocyte glycoprotein (MOG) peptide 35-55 in NOD mice resulted in significant suppression of the development and the severity of the chronic relapsing-remitting experimental autoimmune encephalomyelitis (EAE) both clinically and histologically. The spleen cells from anti-IL-12 antibody treated mice displayed markedly inhibited MOG35-55 specific proliferation and IFN-gamma production. MOG35-55 specific antibody production was enhanced by anti-IL-12 antibody treatment. These results suggest that IL-12 is critically involved in the pathogenesis of MOG-induced EAE and that antibody to IL-12 could be an effective therapeutic agent in the clinical treatment of autoimmune demyelinating diseases such as multiple sclerosis (MS).

Physical and personality traits of preschool children in Fuzhou, China: only child vs sibling

Concern about the healthy growth and development of an only child has been voiced since the 1970s, when the Chinese government launched the only child policy. In this study, the physical and personality traits of rural Chinese preschool only-children (onlies) whose age ranged from 3 to 6 years old were evaluated. The sample included 197 onlies and 367 children with siblings who came from seven kindergartens in rural areas in Fuzhou, Fujian province. The results showed no statistically significant differences in height, mass or BMI between the onlies and siblings. Regarding the personality traits, the significant difference was that the onlies exhibited more somatic complaints, however, the data didn't indicate any other undesirable personality traits for the onlies. These results suggest that Chinese preschool children grow normally with or without siblings.

Suppression of experimental autoimmune encephalomyelitis by dermatan sulfate

The effect of dermatan sulfate (DS) on the treatment of Lewis rats with experimental autoimmune encephalomyelitis (EAE) was examined. DS, a sulfated glycosaminoglycan, has been reported to exhibit anticoagulant and fibrinolytic activities. DS treatment (50 mg/kg/day) facilitates recovery from the clinical manifestations of EAE. In this study, the fibrinolytic activity was higher in DS-treated rats than in saline-treated rats. Although the degree of perivascular mononuclear cell infiltration in the spinal cord was not suppressed in DS-treated rats compared to that in saline-treated rats, perivascular fibrin deposition was markedly suppressed in DS-treated rats. These findings suggest that DS would act as an effective therapeutic agent for EAE by preventing fibrin deposition.