[Evaluation of clinical utility of 99mTc-MIBI scintigraphy in the localization of thyroid, breast and lung/mediastinum tumors--a report of multicenter phase III clinical trials]

Phase III clinical study in 136 patients diagnosed or strongly suspected of thyroid, lung/mediastinum or breast cancer was performed to determine clinical utility of 99mTc-MIBI in the localization of tumors, and the results in 135 were evaluated. Except taste peculiar in 43 patients and nausea in one, no adverse events were reported. Seven abnormal changes in vital signs and 27 in clinical laboratories were noted, which were all judged as having no or unlikely relationship to the agent. Out of 177 malignant lesions, 156 (88%) were detected with 99mTc-MIBI regardless of their histology or location. Of 6 benign tumors, 3 were detected. Fifteen sites of false positive in 11 malignant tumor patients and 5 sites in 6 patients with non-tumor disease were observed. Our study indicates that 99mTc-MIBI is a safe and excellent agent for the localization of tumors. Especially, the fact that 99mTc-MIBI detected remote metastatic lesions with high sensitivity is a great advantage over the other conventional imaging modalities.

Characterization of alpha-maltotetraohydrolase produced by Pseudomonas sp. MS300 isolated from the deepest site of the mariana trench

We have isolated a Pseudomonas-like amylase producer, the strain MS300, which displayed a large halo on starch medium, from the deepest site of the Mariana Trench. The strain MS300 produced two major and two minor alpha-maltotetraohydrolases (G4-amylase). The two major G4-amylases share the same molecular weight of 55,000 but had different pI values, 5.0 and 4.7, respectively. The optimum temperature for activity of both major G4-amylases is 40 degrees C, and the optimum pH is 6.8 for one and 8.9 for the other. MS300 produced more amylase under high hydrostatic pressure than under atmospheric pressure. Strain MS300 may be active in the deep sea at a depth of 10,897 m.

[Evaluation of clinical utility of 99mTc-MIBI scintigraphy in the localization of hyperfunctioning parathyroid lesions in patients with hyperparathyroidism--a report of multicenter phase III clinical trials]

Phase III clinical study in 78 patients with hyperparathyroidism was performed to determine clinical utility of 99mTc-MIBI in the localization of hyperfunctioning parathyroid lesions. Except slight tremor in one patient, no adverse events were reported. No abnormal changes in clinical laboratories or vital signs were noted. The clinical utility of the agent was evaluated in 70 patients. Out of 108 hyperfunctioning glands, 93 (86%) were detected with 99mTc-MIBI regardless of their histology, numbers, or location. Specifically, single or ectopic lesions were detected with high sensitivity (97% and 100%, respectively). Sensitivity in 53 glands with weight data was 79%, while 94% in 36 glands above 200 mg, which is extremely high compared to the 201T1-99mTc subtraction method. Specificity in a group of PHP patients with single adenoma who underwent surgery was 100% (63/63), though in case of coexistent thyroid disease obviously interfered parathyroid images. Our study indicates that 99mTc-MIBI is a safe and excellent agent for the localization of hyperfunctioning parathyroid tissues. Especially, the fact that 99mTc-MIBI detected ectopic glands with high specificity is a great advantage over the ultrasound or 201Tl-99mTc subtraction method.

12-Hydroxyeicosatetraenoic acid directly potentiates angiotensin II-induced vascular contraction

We studied whether 12-hydroxyeicosatetraenoic acid (HETE) affected the angiotensin II-induced contractile response in isolated hamster aorta. After preincubation with 10 nM 12-HETE for 1, 3, 5, 10 and 30 min, the angiotensin II-induced contractions were increased to 101%, 109%, 114%, 109% and 98%, respectively. The optimum preincubation time for the maximum effect of 12-HETE was 5 min. Under these conditions, 12-HETE increased dose dependently the contraction induced by 10 nM angiotensin II, and the concentration needed for the maximum effect was 30 nM, which increased contraction to 118% compared to the control angiotensin II-induced contraction. We demonstrated clearly that 12-HETE directly potentiates the angiotensin II-induced contraction.

Combination chemotherapy in a patient with severe multiple systemic autoimmune disease

We describe the occurrence of autoimmune haemolytic anaemia (AIHA) in a patient who had had both idiopathic thrombocytopenic purpura (ITP) and bullous pemphigoid (BP) for about 10 years. All of these diseases worsened rapidly, and the patient's clinical condition became critical after an episode of acute pneumonia. His AIHA, ITP and BP were responsive to combination chemotherapy consisting of cyclophosphamide, vincristine and prednisolone (CVP therapy).

Somatostatin-receptor-negative carcinoid tumour responsible for Cushing's syndrome

A 30-year-old man presenting with Cushing's syndrome was admitted in 1995. A diagnosis of ectopically ACTH-secreting, primary-unknown abdominal carcinoid tumour was made. The patient's plasma ACTH and cortisol levels failed to decrease after short-term treatment with octreotide, and somatostatin-receptor scintigraphy did not show any accumulation in the tumour. The patient died 1 year after admission. This is a relatively rare somatostatin-receptor-negative case of this disease and it appears necessary to test for the presence of somatostatin receptors before treating with octreotide.

Development and practical use of the new quantitative bleeding time test apparatus

We have developed a new computerized system for measurement of quantitative bleeding time (QBT) to detect subtle abnormalities of primary hemostasis that are difficult to detect with the standard bleeding time determination. This new apparatus can simultaneously measure the bleeding time (BT; sec), amount of total blood loss (Tv; microl), maximum bleeding rate (Rmax; microl/sec) and bleeding pattern from the bleeding time incision. We have also developed a new holder for the Simplate that enables more consistent incisions and thus improves the reproducibility of the BT test. In this study, the newly developed QBT test was performed in 137 normal healthy volunteers and 10 patients having defined abnormalities of either primary or secondary hemostasis. Comparisons of the standard BT test and our QBT were made in 5 normal subjects and 7 thrombocytopenic patients. Additionally, 6 normal subjects were examined with both tests before and after administration of aspirin. Those results show that our QBT appears to be a more sensitive indicator of primary hemostasis than the standard BT method.

Mutational analysis of the RET proto-oncogene in 71 Japanese patients with medullary thyroid carcinoma

Multiple endocrine neoplasia types 2A and 2B (MEN2A and MEN2B) and familial medullary thyroid carcinomas (FMTC) are caused by germline mutations in the RET proto-oncogene. To investigate the spectrum of RET mutations among Japanese patients, we screened the RET gene in 71 patients with thyroid carcinomas. The panel included representatives of 44 families carrying FMTC or MEN2, 22 sporadic medullary thyroid carcinomas (MTCs), and five MTCs without familial information. Mutations in nucleotide sequences encoding one of three specific cysteine residues in the extracellular domain of the RET protein were found in 33 of the 34 MEN2A patients and in five of the six FMTC patients examined. A mutation at codon 918, causing the substitution of threonine for methionine in the tyrosine kinase domain of the protein, was found in germline DNAs of all four patients with MEN2B and in two of the 22 patients with sporadic MTCs; codon 918 was mutated somatically in tumor DNAs from three other sporadic cases. Germline mutations of codon 768, GAG to GAC (Glu to Asp), were detected in one FMTC, in one patient with sporadic MTC, and in one of the patients without familial information. Two somatic mutations, an Asp to Gly substitution at codon 631 and a Cys to Arg substitution at codon 634, had not been reported previously. Of five germline mutations found among the 22 sporadic cases, four were confirmed as de novo mutations since in each case neither parent carried the mutation. As nearly one-fourth of the patients with sporadic MTCs carried germline mutations and 50% of their children are expected to develop MTC and other endocrine tumors, these results indicated the importance of careful clinical surveillance of family members of any patient with MTC.

Rupture of the flexor pollicis longus tendon at the musculotendinous junction in a bowler

Traumatic rupture of the flexor tendons at the musculotendinous junction is rare. A case of flexor pollicis longus tendon rupture at the musculotendinous junction is described. The mechanism of the tendon injury appears to be longitudinal traction on the contracted muscle during delivery of a bowling ball.

Sustained improvement in anemia with low-dose recombinant human erythropoietin therapy in a patient with hypoplastic myelodysplastic syndrome and chromosomal abnormalities

We present a case report of a 55-year-old male patient with hypoplastic myelodysplastic syndrome (MDS, refractory anemia) in which a good response to recombinant human erythropoietin (rhEPO) has been maintained for more than 60 months. There is with no evidence of progression to high risk MDS or acute leukemia, although he was predicted to be a low-responder to rhEPO therapy because of very high serum EPO levels (5,260 mU/ml), a history of multiple transfusions, chromosomal abnormalities (47,XY,+8) and severe thrombocytopenia. Since he received rhEPO with no adverse effects, it may be valuable to try rhEPO treatment at least one time for low-risk MDS patients, depending on red cell transfusion requirements.

Solitary splenic metastasis of a carcinoid tumor of the lung eight years postoperatively

The case of a 49-year-old male who was found to have a solitary splenic metastasis 8 years after undergoing right upper lobectomy for Stage 1 (pT1N0M0) bronchopulmonary carcinoid tumor and was treated by splenectomy is reported. Metastasis of bronchopulmonary carcinoid tumors to the spleen is very rare. However, it is important to bear in mind that there are patients with solitary splenic metastasis who have a favorable outcome.

Pregnancy among long-term survivors of acute leukemia. A second nationwide survey

A second nationwide survey was conducted to determine the outcome of pregnancy in long-term survivors of acute leukemia and to clarify the influence of treatment on the offspring of long-term survivors. In July 1996, 336 survey responses were received from the 498 Japanese institutions surveyed. A total of 89 cases (39 spouses of male patients and 50 female patients) who had babies during their first remission were analyzed, including 43 patients from the first survey in 1991. Median age at the birth of first baby was 30.7 years for male patients and 28.6 years for female patients. A total of 109 of the 117 pregnancies resulted in live births and eight resulted in abortions. A total of 58 cases had single children and 23 cases had two or more, generally from separate pregnancies, but including two pairs of twins. The infant was male in 59 cases, female in 37 and gender was not reported in 13 cases. Ages of children ranged from 2 months to 20 years at the time of this study and all children were in good health. There were two minor anomalies, both of which were surgically corrected. Of the 81 parents bearing live infants, 75 remained in complete remission. Five fathers died (four of relapse and one of another disease). In conclusion, there was no apparent increase in pregnancy complications or congenital anomalies in the children of long-term survivors with acute leukemia.

Combination of calcitonin and pamidronate for emergency treatment of malignant hypercalcemia

To combine the rapid hypocalcemic effects of calcitonin with the delayed effects of pamidronate, a combination of a single dose of pamidronate and serial doses of eel calcitonin was administered to five patients with malignant hypercalcemia for 2 to 5 days. The serum calcium levels of all five patients fell within 24 h after administration of pamidronate and the first dose of calcitonin and decreased to normal within 4 days. The mean level of corrected serum calcium fell from 15.3 mg/dl (range 14.1-16.4 ) to 9.2 mg/dl (8.9-9. 6) at the nadir. No toxicity or side effects were found. The results of this study demonstrate the value of combining the rapidly acting antiresorptive and renal calciuretic effects of calcitonin with the slower, but more potent effects of pamidronate. The combination of calcitonin and pamidronate allowed rapid, long-term control of hypercalcemia and it is regarded as the first choice of treatment in severe hypercalcemia.

[Hematological characteristics of hypoplastic MDS patients with chromosomal abnormalities, who had been followed for aplastic anemia with normal karyotypes]

During 1990 to 1993, five patients who had been treated in our hospital for aplastic anemia (AA) with a normal karyotype, were found to have hypoplastic myelodysplastic syndromes (hMDS); three patients with RA, one RAEB, and one RAEB-T, and all of them have chromosomal abnormalities. The mean age of the hMDS patients (4 men, 1 woman) was 51.0 years (range 31-61). We retrospectively studied the hematological features of the 5 cases in the early stage without chromosomal abnormalities. They showed, 1) appearance of erythroblasts (3/5), 2) more reticulocyte counts than typical AA (mean 7.8 x 10(4)/microliter), 3) macrocytic anemia (mean MCV 106fl) in peripheral blood, 4) relative erythroid hyperplasia (M/E ratio 0.2-1.5), and 5) low lymphocyte counts (mean percentage of lymphocytes 32, 8%) in bone marrow. Considering about the differences or transformation between AA and hMDS, it is interesting that all five patients have initially had a normal karyotype and subsequently developed chromosomal abnormalities.

Aspirin effects on colonic mucosal bleeding: implications for colonic biopsy and polypectomy

BACKGROUND

Many patients who require endoscopic treatments such as biopsy and polypectomy are given antiplatelet agents reluctantly. We have studied the effects of aspirin on colonic mucosal hemostasis.

METHODS AND PATIENTS

We developed a new endoscopic device to make a standard incision (7-mm length) on the colonic mucosa to study colon bleeding time. We measured the colon bleeding time of normal colonic mucosa in 47 cases. The colon bleeding time and skin bleeding time (Simplate method) were measured before and one hour after aspirin ingestion (990 mg) in ten healthy subjects.

RESULTS

The bleeding time of normal colonic mucosa was 156 +/- 71 (mean +/- standard deviation) seconds. Significant prolongation was noted in both skin bleeding time (357 +/- 192 vs. 477 +/- 183 seconds; P < 0.05) and colon bleeding time (155 +/- 47 vs. 244 +/- 169 seconds; P < 0.05) after aspirin ingestion.

CONCLUSIONS

Bleeding time was measured safely under direct colonoscopic visualization. Aspirin prolonged the colon bleeding time. Therefore, endoscopists should be aware of a risk of abnormal bleeding after endoscopic biopsy and polypectomy in patients with aspirin use. Two days were necessary for colon bleeding time to become normalized in patients with aspirin use.

Attritional flexor tendon ruptures after a malunited intra-articular fracture of the distal radius

Rupture of the flexor tendon following Colles fracture is uncommon. In all reported cases it occurred as a complication of an extra-articular, displaced fracture of the distal radius. We report a case in which flexor tendon rupture occurred 30 years after a comminuted intra-articular fracture of the distal end of the radius. There have been no reports of delayed flexor tendon rupture after an intra-articular fracture of the distal radius in young adults.

Flexor digitorum profundus avulsion with associated fracture of the distal phalanx

Two unusual cases of flexor digitorum profundus avulsion with an associated fracture of the distal phalanx are reported. In one case the injury consisted of avulsion of a large bone fragment from the distal phalanx and an associated profundus avulsion from the fragment. The other case showed simultaneous shaft fracture of the distal phalanx with avulsion of the profundus tendon, which could not be included in the existing classification of profundus injuries. The latter injury was misdiagnosed initially.

Isolated volar displaced fracture of the ulnar condyle at the base of the index metacarpal: a case report

A case involving a displaced fracture of the ulnar condyle at the base of the second metacarpal without concomitant dislocation of the second carpometacarpal joint is described. It seems probable that the fracture was produced by simultaneous volar subluxation of the base of the third metacarpal that reduced spontaneously. Open reduction and internal fixation of the fracture with Kirschner wires achieved satisfactory results.

Laparoscopic adrenalectomy in asymptomatic pheochromocytoma

A patient with asymptomatic pheochromocytoma associated with catecholamine hypersecretion but no hypertension was treated by right laparoscopic adrenalectomy. The 63-year-old male patient was referred to us for treatment of an incidentaloma. The diameter of the adrenal tumor was 50 mm, and the peripheral blood nonrepinephrine level was 1.12 ng/ml (normal level, 0.4 ng/ml). Blood pressure was normal. A flexible electron laparoscope was used for open laparoscopy, and four trocars were inserted. The retroperitoneum was incised to the right of the inferior vena cava, and the tumor was excised. During the operation, blood pressure rose transiently, and a blocker and nitroglycerin were administered. The tumor bled extremely easily. The duration of surgery was 3 hours and 20 minutes, and blood loss was 210 ml. The excised tumor was 55 mm in diameter. The patients's postoperative course was uneventful. If the size of asymptomatic pheochromocytoma is not large, and blood pressure and cardiac function are stable, laparoscopic adrenalectomy is indicated for this type of tumor as long as it is performed by experienced surgeons.

Microbial flora in the deepest sea mud of the Mariana Trench

In an attempt to characterize the microbial flora on the deepest sea floor, we isolated thousands of microbes from a mud sample collected from the Mariana Trench. The microbial flora found at a depth of 10897 m was composed of actinomycetes, fungi, non-extremophilic bacteria, and various extremophilic bacteria such as alkaliphiles, thermophiles, and psychrophiles. Phylogenetic analysis of Mariana isolates based on 16S rDNA sequences revealed that a wide range of taxa were represented.