Photopsia as a manifestation of digitalis toxicity

CASE REPORT

To present a case of photopsia resulting from digoxin intoxication brought about by dehydration in a 72-year-old woman.

COMMENTS

Ophthalmologists may be the first clinicians to notice the symptoms of digitalis intoxication, which is potentially a life-threatening condition.

Orbital Amyloidosis–induced Compressive Optic neuropathy Accompanied by Characteristic Eyelid Pigmentation

The deposition of amyloid protein in orbital tissue is called orbital amyloidosis. Orbital amyloidosis is a rare condition that usually affects older patients. Although the disease is slowly progressive, it rarely involves the optic nerve or threatens vision. We report a case of orbital amyloidosis that initially appeared as impressive eyelid pigmentation and blepharoptosis and then progressed to systemic amyloidosis. The orbital lesion induced compressive optic neuropathy. Surgical management enabled partial but not full recovery of vision.

Molecular cloning and characterization of novel splicing variants of human decay-accelerating factor

Decay-accelerating factor (DAF) is one of the complement regulatory proteins. Two isoforms of DAF have been identified in humans. In this study, we isolated novel cDNAs encoding five isoforms of DAF from the human lung, which were generated by insertion of new exonic sequences. RT-PCR revealed that all isoforms were expressed in almost all tissues tested, although the expression patterns and levels differed among the tissues. Transfection of isoform vDAF1, 2, and 3 cDNAs into CHO cells showed that these molecules are soluble forms secreted after glycosylation. Isoform vDAF4 and vDAF5 cDNAs included a part of and the entire intron 7 sequence, respectively, and the transfection of vDAF4 cDNA produced a large, glycosylated, membrane-bound form. These results suggest that more than seven isoforms of human DAF are involved in the regulation of complement activation under physiological conditions through their specific structures and localization.

EXTENT OF MEDIASTINAL LYMPH NODE DISSECTION FOR CLINICAL T1 NON-SMALL CELL LUNG CANCER

The present study was designed to determine the extent of lymph node dissection for clinical T1 non-small cell lung cancer without negatively influencing curability. The study included 192 cases with clinical T1 non-small cell lung cancers who underwent lobectomy with mediastinal lymphadenectomy. Among 69 cases with right upper lobe tumors, metastasis was found in subcarinal lymph node in one case only. No metastasis was found in subcarinal node in cases free of metastasis in hilar and/or superior mediastinal nodes. Among 33 cases with right lower lobe tumors, metastasis was detected in the superior mediastinal node only in cases with metastasis in hilar and/or subcarinal nodes. Among 51 cases with left upper lobe tumors, no metastasis was found in the subcarinal node. Among 22 cases with left lower lobe tumors, metastasis was found in the superior mediastinal nodes only in cases with metastasis in hilar and/or subcarinal nodes. We propose the following scheme for the extent of mediastinal node dissection. Dissection of mediastinal node for clinical T1 non-small cell lung cancer cannot be omitted. But, 1) for upper lobe tumors, subcarinal lymphadenectomy could be omitted if no metastasis is found in hilar and superior mediastinal nodes based on gross and microscopic examination of frozen sections. 2) Similarly, for lower lobe tumors, superior mediastinal lymphadenectomy could be omitted if no metastasis is detected in the hilar and subcarinal nodes.

PREOPERATIVE PULMONARY FUNCTION AS A PREDICTOR OF RESPIRATORY COMPLICATIONS AND MORTALITY IN PATIENTS UNDERGOING LUNG CANCER RESECTION

OBJECTIVE

We evaluated preoperative pulmonary function as a predictor of respiratory complications and mortality in patients undergoing lung cancer resection to confirm the guideline of the British Thoracic Society: lung cancer surgery in patients with predictive postoperative FEV(1.0) (%FEV(1.0)ppo) > 40% and predictive postoperative diffusion capacity for carbon monoxide (%DL(co)ppo) > 40% can be carried out with average risk.

METHODS

We retrospectively studied 356 consecutive patients who underwent pulmonary resection at our Department from January 1992 to December 2001. Preoperative pulmonary function tests included vital capacity (VC), %VC, forced expiratory volume in one second (FEV(1.0)), FEV(1.0)%, diffusion capacity for carbon monoxide (DL(co)), predictive postoperative FEV(1.0) (FEV(1.0)ppo), postoperative respiratory function expressed as a percentage of the predicted normal value (%FEV(1.0) ppo, %DL(co)ppo). Postoperative complications were divided into 2 groups: respiratory complications (pneumonia, atelectasis, etc) and other complications (bronchopleural fistula, prolonged air leak, arrhythmia, etc).

RESULTS

Postoperative deaths occurred in 14 (3.9%) patients. Postoperative respiratory complications developed in 27 (7.6%) patients. Pneumonectomy (p < 0.001), preoperative chemotherapy (p < 0.01) and advanced stage (p < 0.05) were identified as risk factors of postoperative deaths. Patients undergoing lobectomy with FEV(1.0) > or = 1,500 ml did not die of respiratory complications. Patients undergoing pneumonectomy with FEV(1.0)ppo > or = 800ml/m2 did not die of respiratory complications. Patients undergoing pneumonectomy with %FEV(1.0)ppo < 40% and %DL(co)ppo < 40% did not survive. Five of the 7 patients who died of respiratory complications were treated with preoperative chemotherapy. The values of their %DL(co)ppo were all less than 40%. By multivariate analysis, %FEV(1.0)ppo was significant independent factor associated postoperative death.

CONCLUSIONS

We conclude that the guideline is useful for the selection for surgery of lung cancer patients. If preoperative chemotherapy is performed, the measurement of %DL(co) is recommended before surgery.

Crystal structure and preferred conformation of beta-lactams derived from (S)-1-arylethyl isocyanates and vinyl ethers

The configurational analysis of beta-lactams prepared from [2 + 2] cycloaddition of vinyl ethers to pure enantiomers of 1-arylethyl isocyanates was carried out by high resolution 1H NMR. The addition of a chiral shift reagent revealed that the most important conformation of the studied beta-lactams in solution is that in which the methine proton, of the exocyclic stereogenic carbon, points towards the carbonyl oxygen atom. Since the configuration of the stereogenic exocyclic carbon is known, the orientation of the aromatic ring allows the correlation of the chemical shifts with the absolute configuration of the new stereogenic centers. This method is particularly useful to establish the stereochemistry of oily beta-lactams having the N-(1-arylethyl) group. The X-ray crystallographic analysis carried out with (1R,5S)-7-[(1S)-1-(1-naphthyl) ethyl]-2-oxa-7-azabicyclo[3.2.0]heptan-6-one, is consistent with the proposed model for beta-lactams in solution.

The effect of nitric oxide production by sinusoidal endothelial cells on preservation injury during cold ischemia

Multifactorial elements are responsible for preservation and reperfusion injury in liver allografts. Sinusoidal endothelial cells (SECs) are a primary target of cold preservation injury of the liver. We examined the correlation between nitric oxide (NO) production by SECs and their injury during cold preservation. SECs were isolated from rat livers and preserved in either Euro-Collins (EC) or University of Wisconsin (UW) solution. Injury to the SECs was more severe when preserved in the EC solution than in the UW solution during cold ischemia. In addition, NO production by SECs was found to be proportionate to the cell injury. Cell viability was not improved by the addition of NO inhibitor, L-NMMA. Further, NO inhibitor was detrimental to the SECs in a 24-h preservation in UW solution. LDH release by SECs preserved in UW solution supplemented with L-NMMA was 11.10+/-2.03 IU/l, while that in UW solution alone was 3.70+/-0.70 IU/l (P<0.01). Together, our results suggest that NO protects SECs during cold preservation and that NO from SECs may have beneficial effects on the liver during cold ischemia.

Experimental hypocalcemia induced by hemodialysis in goats

To evaluate whether hemodialysis with a dialysate containing no calcium (Ca-free HD) can induce hypocalcemia and restore the clinical signs and blood biochemical changes in naturally occurred hypocalcemic disorder in ruminants, the clinical signs and the changes in plasma electrolytes and minerals concentrations were observed in goats during 6-hr hemodialysis. The four goats received hemodialysis with the dialysate containing calcium (Ca HD), and 10 days later they had Ca-free HD. The plasma ionized Ca (Ca++) and total Ca (TCa) concentrations were not affected by Ca HD, whereas the levels significantly decreased during whole period of Ca-free HD. The Ca++ and TCa concentrations were 0.69+/-0.06 mmol/l and 5.9+/-0.3 mg/dl at 6 hr of Ca-free HD, respectively. The clinical signs observed during Ca-free HD seemed to resemble to those in naturally occurred hypocalcemic cases that were reported previously. Therefore, Ca-free HD was suggested to be one of the possible methods to induce experimental hypocalcemia in ruminants.

Placenta accreta/increta. Review of 10 cases and a case report

A review of the patients seen at the Department of Obstetrics at Dokkyo University Hospital who had suffered placenta accreta/increta in the past 18 years, was performed. There were 10 such cases out of 9,716 deliveries during this period. This incidence is higher than that which has been reported in other Western countries. Forty percent of the patients in our study had placenta accreta/increta accompanied by placenta previa or low lying; 30% had had a prior cesarean section (C/S); 70% had previously experienced dilatation and curettage (D & C); 80% had previously undergone a C/S and/or D & C: and 40% had a history of miscarriage. Three of the ten patients with placenta accreta/increta required a hysterectomy; 2 patients were successfully treated with hemostatic stitches on the endometrium; and the remaining 5 mild cases were treated with removal of the placenta, either manually or with the use of forceps. There was no case of maternal death. In 2 cases, neonatal asphyxia was noted, but the neonate immediately recovered.

Enhancement of enzyme reaction of magnetically anisotropic polyacrylamide gel rods immobilized with ferromagnetic powder and beta-D-galactosidase in an alternating magnetic field

An immobilized polyacrylamide gel containing beta-D-galactosidase and Sr-Ba-ferrite was magnetized in a static magnetic field. The gel rods (10 mm long, O 2 mm) exhibiting magnetic anisotropy could move at lower than 100 Hz but not at higher than 250 Hz in an alternating magnetic field of 200 Oe. In case of immovability of gel rods, the apparent enzymic activity increased 3 times higher under exposure of an alternating magnetic field of 500 Oe (570 Hz). It could be explained that the ferromagnetic powder inside the gel might vibrate under the influence of elasticity of gel in the alternating magnetic field of 100 or 500 Oe and 0.2-12 kHz. This might facilitate faster diffusion of the substance inside the gel and transportation of the substrate and the product through the surface of gel. Consequently, the enzyme reaction was apparently activated.

Radiographical evaluation of bone maturation in Japanese black beef cattle

Epiphyseal ossification in the radius, ulna, metacarpus, proximal phalanx and tuber calcaneus was examined radiographically in Japanese Black beef cattle. The grade of standard ossification was assessed monthly for each epiphysis. Bone maturations could be divided into 8 grades for the distal radius and distal ulna, 7 grades for the distal metacarpus, 5 grades for the proximal phalanx, and 8 grades for the tuber calcaneus, respectively. The closure of the epiphyseal line completed at the earliest (12-14 months of age) on the proximal phalanx, and at the latest (35-37 months of age) on the distal ulna. Changes in gradings were steep at 0 to 5 months of age but became almost constant after 10 months of age in all the epiphyses. There were no significant differences in bone maturation between the cattle with different sex and breeding conditions.

Racial factors cannot explain superior Japanese outcomes in stomach cancer

OBJECTIVE

To compare the stage-stratified survival of Japanese patients treated in Honolulu according to Western techniques with that of Japanese patients treated in Tokyo according to Japanese techniques, thus eliminating race as a potentially confounding variable.

DESIGN AND PATIENTS

Of 312 Honolulu Japanese patients surviving Western-type gastric resection for neoplasm between 1974 and 1985, 279 were identified with invasive gastric adenocarcinoma unassociated with any second malignancy. This Honolulu cohort, treated by Western methods, was retrospectively compared with a similar, previously described cohort of 3176 Tokyo Japanese patients treated according to Japanese methods.

MAIN OUTCOME MEASURES

American Joint Committee on Cancer/Union Internationale Contre le Cancer criteria for stage-stratified survival.

RESULTS

Despite non-TNM prognostic factors favoring higher survival for the Honolulu Japanese patients, for every TNM stage, we observed higher survival for the Tokyo Japanese patients who were treated according to Japanese techniques. For stage I disease, the survival rates were 86% vs 96%, respectively (P < .001); for state II, 69% vas 77% (P = .15); for stage III, 21% vs 49% (P < .001); and for stage IV, 4% vs 14% (P < .001).

CONCLUSIONS

Because all patients in this study are Japanese, race-related factors or the "different-disease" hypothesis cannot explain these results. Lymphadenectomy-related stage-migration and/or differing therapeutic efficacy seem more likely explanations.

Preventive effects of recombinant human erythropoietin administration on anemia associated with repeated hemodialysis in nephrectomized dogs

The preventive effects of recombinant human erythropoietin (rhEPO) administration on progression of anemia were evaluated during hemodialysis in nephrectomized dogs. In control dogs given no rhEPO, anemia gradually progressed with repeated hemodialysis and with little erythropoietic response observed in the bone marrow. In dogs administered with rhEPO, however, an active erythropoietic response was induced in the bone marrow, indicating that anemia due to hemodialysis was being prevented.

Canine plasma erythropoietin levels in 124 cases of anemia

Erythropoietin (EPO) levels in plasma from 124 clinically anemic dogs were determined by in vivo bioassay. In 81 anemic dogs with normal renal function, the concentration of plasma EPO showed a close correlation with the hemoglobin concentration. The plasma EPO level was obviously decreased in 43 anemic dogs with renal failure. Of these dogs with renal failure, 17 showed no detectable plasma EPO and resulted in the death of these dogs. In the remaining 26 dogs having detectable plasma EPO, the plasma concentration rate of EPO related to blood urea nitrogen and serum creatinine values.

Evaluation of erythropoietin production in dogs with reduced functional renal tissue

This study was designed to determine the quantity of functional renal tissue needed to maintain homeostasis of red blood cell production by evaluating the erythropoietin (EPO) production response to phlebotomic stimulation in the 1/2- and 1/4-kidney dogs surgically prepared. The results showed that the reduction in functional renal tissue caused a decrease in EPO production, which led to the delay in recovery from anemia. In the anemic progress stage, the plasma EPO level showed a transition proportional to the quantity of functional renal tissue immediately after the operation for tissue reduction. The 1/2-kidney dog group still kept such proportional relation even in the recovery stage. Thus, the half of the normal renal tissue was considered sufficiently contributory to EPO production needed to maintain homeostasis of red blood cell production. However, the 1/4-kidney dog group precipitously decreased in plasma EPO level in the recovery stage and fell into an extremely unfavorable anemia. This indicated that homeostatic maintenance in erythropoiesis would be impossible more below a quarter of normal renal tissue. These findings disclosed that reduction in functional renal tissue quantity would sensitively influence homeostatic maintenance of red blood cell production through the decrease in EPO production, even if it does not affect renal function concerned with urine production.

Evaluation of phlebotomy-induced erythropoietin production in the dog

Erythropoietin (EPO) production in dogs was studied by reducing red blood cells with phlebotomy. In this study, the hemoglobin reduction rate (delta %Hb) was newly taken into account as the regulating factor for EPO production, and its usefulness to estimate the stimulating intensity to EPO production was examined. As the result, plasma EPO was highly correlated with delta %Hb showing the importance related to regulation of EPO production, in the increasing plasma EPO by different degrees of phlebotomy, in the change of plasma EPO through the anemia progress and recovery period after severe phlebotomy, and in the initial variation of plasma EPO induced by chronic mild phlebotomy. On the other hand, increasing EPO production appeared at least within 6 hr after acute severe phlebotomy, which revealed significantly higher plasma level compared with the mild chronic phlebotomy, suggesting the effect of time leading to red blood cell reduction on EPO production response. Simultaneously, considering an in vivo EPO half life of 8.4 hr calculated from plasma EPO disappearance after bilateral nephrectomy, endogenous plasma EPO accumulation should be taken into consideration in rapidly increasing of delta %Hb.

Evaluation of plasma erythropoietin levels in normal adult dogs by in vivo bioassay using concentrated plasma

Measurement of plasma erythropoietin level in normal dogs by in vivo bioassay has been considered to be impossible so far. In the present study, we successfully determined it by using concentrated plasma 60 times which allowed the lower limit to 2.7 mU/ml. This normal plasma erythropoietin level was the first to be determined as an in vivo bioactivity and was 9.14 +/- 7.81 mU/ml in 75 normal adult dogs. This value was sufficiently reliable in terms of accuracy of determination and considered to be meaningful as the low level in vivo bioactivity that hasn't been known to date. Furthermore, erythropoietin levels in normal plasma were within a certain lower range and showed neither difference in plasma erythropoietin level between males and females or among breeds nor correlation between erythropoietin and hemoglobin level.

Endocrine cells and prognosis in patients with colorectal carcinoma

Using chromogranin (CG) immunohistochemical staining, the prognostic significance of endocrine differentiation was investigated in 212 patients with primary colorectal adenocarcinoma (including 6 patients with mucosal carcinoma). CG-immunoreactive cells were found to be an integral component of the tumor in 67 of 206 patients (32.5%, excluding mucosal carcinoma). The intracellular localization of CG in the CG-immunoreactive cells in cancer tissue was completely different from that in the normal endocrine cells of the large bowel. In addition, morphologic changes such as nuclear hyperchromasia and pleomorphism also indicated that the CG-immunoreactive cells in the cancer tissue were malignant. The tumors were divided into three groups based on the frequency of CG-immunoreactive cells: Group I (n = 139), negative; Group II (n = 38), less than 1 positive cell/mm2; and Group III (n = 29), more than 1 positive cell/mm2. No correlation was observed between CG-immunoreactivity (CG-IR) and tumor location, grade, depth of invasion, or stage, regardless of lymph node involvement. However, patients with numerous endocrine tumor cells (Group III) had a significantly worse prognosis compared with patients without endocrine cells (Group I) (multivariate Cox's model, P less than 0.01). Similar findings were observed in patients with node-negative tumor (multivariate Cox's model, P less than 0.05). These results indicated that the neuroendocrine differentiation is an independent prognostic factor and that CG-immunohistochemistry is useful for detecting a subgroup with a worse prognosis among patients with colorectal cancer.