[Pseudohypoxemia in a patient with chronic myeloid leukemia and splenomegaly]

A 35-year-old man with chronic myeloid leukemia whose peripheral leukocyte count was 18.6 x 10(4).mm-3 underwent splenectomy. Perioperative arterial blood gas analysis showed lower oxygen saturations than those measured with pulse oximetry. The findings suggested pseudohypoxemia because of marked leukocytosis.

Bilateral simultaneous oblique MR imaging of the proximal femur

Oblique axial and oblique coronal MR images parallel to the femoral neck provide more valuable information concerning the proximal femur than orthogonal images. The main disadvantage of the unilateral oblique imaging is that the imaging time is significantly increased when both hips need to be imaged. If the bilateral oblique imaging is performed simultaneously, this increase in imaging time is eliminated because the scanning time for the bilateral oblique imaging and the orthogonal imaging is the same.

Comparison of standard coronary artery bypass grafting and minimary invasive direct coronary artery bypass grafting. Early and mid-term result

OBJECTIVES

We studied indications and problems involved in minimally invasive coronary artery bypass grafting (MIDCAB).

METHODS

We compared patients profiles, graft patency, stenosis severity, morbidity, mortality, long-term survival and freedom from cardiac accidents in 174 patients undergoing elective standard coronary artery bypass grafting (CABG) and 128 undergoing between January 1996 and March 1999.

RESULTS

No statistically difference was seen in gender, diabetes mellitus, renal failure, cerebrovascular accident, multi-vessel disease ratios, or left main trunk stenosis between 2 groups. Internal thoracic artery graft patency was 97% (114/118) and the rate of anastomotic stenosis (> 50%) was 9% (10/118) compared to 96% (213/221) in the MIDCAB group. The 3-year survival rate was 91% in the MIDCAB group and 92% in the CABG group and freedom from cardiac accidents, most involving pericutaneus transluminal coronary angioplasty retreatment, was 66% in the MIDCAB group and 88% in the CABG group.

CONCLUSION

Although patency and stenosis incidence did not differ between 2 groups, freedom from cardiac accidents was lower in the MIDCAB group.

Absorption of chlorogenic acid and caffeic acid in rats after oral administration

Absorption of orally administered chlorogenic acid (5-caffeoylquinic acid) and caffeic acid in rats was studied to obtain plasma pharmacokinetic profiles of their metabolites. Rats were administered 700 micromol/kg body weight of chlorogenic or caffeic acid, and blood was collected from the tail for 6 h after administration. Ingested caffeic acid was absorbed from the alimentary tract and was present in the rat blood circulation in the form of various metabolites. On the other hand, only traces of metabolites, supposedly caffeic and ferulic acids conjugates, were detected in rat plasma for 6 h after chlorogenic acid administration. Chlorogenic acid and small amounts of caffeic acid were found in the small intestine for 6 h after chlorogenic acid administration. These results suggest that chlorogenic acid is not well absorbed from the digestive tract, unlike caffeic acid, and subject to almost no structural changes to the easily absorbed forms.

Autoimmune cholangiopathy associated with rheumatoid arthritis

We herein describe a patient with autoimmune cholangiopathy complicated with rheumatoid arthritis. A 58-year-old female was admitted to our hospital due to complications of arthralgia in her fingers, shoulders, elbows, knees and ankles. She presented with abnormally elevated levels of transaminases, alkaline phosphatase and was also negative for hepatitis B virus, hepatitis C virus and the serum mitochondrial antibody test, but had high titers of serum antinuclear antibody, rheumatoid factor and rheumatoid arthritis hemagglutination. A liver biopsy specimen showed chronic non-suppurative destructive cholangitis. She was thus diagnosed to have autoimmune cholangiopathy and rheumatoid arthritis. She began treatment with prednisolone 40 mg per day. After 20 days of steroid therapy, her hepatic function tests improved and the arthralgia symptoms disappeared. This is, to our knowledge, the first case of autoimmune cholangiopathy associated with rheumatoid arthritis, in which both symptoms improved with steroid therapy.

Autoimmune pancreatitis detected as a mass in the tail of the pancreas

A mass in the tail of the pancreas was detected in a 62-year-old male patient who had hypergammaglobulinaemia, and was positive for antinuclear antigen and anti-SS-A antibody. Endoscopic retrograde pancreatography revealed focal irregular narrowing of the main pancreatic duct in the tail of the pancreas. Dynamic computed tomography showed swelling of the pancreatic tail, which was enhanced on delayed phase. Autoimmune pancreatitis was suspected and corticosteroid therapy was commenced. This led to significant resolution of the pancreatic stricture. It is important to recognize this clinical entity as corticosteroid therapy may avoid unnecessary surgery.

A pulse of blue light induces a transient increase in activity of apoplastic K+ in laminar pulvinus of Phaseolus vulgaris L

A pulse of blue light induced both a transient increase in activity of apoplastic K+ and membrane depolarization in laminar pulvinus of Phaseolus vulgaris L. This shows that blue-light-induced net efflux of K+ from motor cells is closely related to membrane depolarization.

Oxygen supply-consumption balance in the thigh muscles during exhausting knee-extension exercise

The purpose of this study was to investigate the difference in muscle oxygenation between the individual muscles involved in an exhaustive knee-extension exercise. Eight active women performed exercise by extending the knee joint from 90 degrees to 30 degrees (60 extensions min-1) at 20%, 30%, and 40% maximum voluntary contraction (MVC). Changes in oxy-(delta HbO2), deoxy-(delta Hb), and total (delta HbT) hemoglobin concentrations, and oxygen saturation (delta SO2NIRS = HbO2/HbT) in the vastus lateralis (VL) and rectus femoris (RF) muscles were measured with a spatially resolved near-infrared spectrometer (NIRS). The delta SO2NIRS in the VL and RF decreased rapidly from the pre-exercise control value (VL: 75.6 +/- 0.9%; RF: 81.6 +/- 1.6%) at the onset of exercise at three different intensities, although no significant difference in delta SO2NIRS was found between the two muscles at this time. However, the delta SO2NIRS decreased more rapidly thereafter and reached a lower value at exhaustion in the VL than in the RF. The difference in delta SO2NIRS between the VL (-10.3 +/- 1.7%) and RF (-4.0 +/- 1.0%) was significant (p < 0.05) when exercise intensity was 30% MVC. When the decreases in delta HbO2 and delta HbT (p < 0.05) were compared at different exercise intensities, the values at 30% and 40% MVC were significantly lower (delta HbO2: p < 0.01; delta HbT: p < 0.05) than those at 20% MVC in the VL, but there was no significant difference in any of the parameters in the RF, or in delta Hb in the VL. These results suggest that the muscle oxidative response to exhaustive knee-extension exercise differed between the VL and RF muscles. At exhaustion, oxygen saturation decreased to a lower level in the VL than in the RF, and an intensity-dependent difference in muscle oxygenation parameters was observed at 30% MVC in the VL but not in the RF muscles.

[Intratumoral ethanol injection therapy using endoscopic video information system]

Bronchoscopic ethanol injection (BEI) therapy for endobronchial malignant tumor is thought to be an effective modality for airway dilatation and hemostasis without expensive special equipment. But if ethanol leaks into the airway, it causes severe coughing and erosion of bronchial wall. Using endoscopic video information system (EVIS), an assistant operator can observe an ethanol leak and inject an adequate volume. To evaluate the efficacy and adverse effect of BEI therapy, we treated 8 patients with endobronchial malignant tumor using EVIS. Under local anesthesia, a video-bronchoscope (Olympus BF200 or BF 1T200) was inserted orally, a transbronchial aspiration cytology (TBAC) needle was inserted via the biopsy channel, and injections of 0.2 ml of 99% ethanol into the tumor were repeated. After the tumor degenerated to necrotic tissue, it was removed with a biopsy forceps, and this maneuver was repeated for the existing fresh lesion. The total volume of injected ethanol was 4.5 + 1.6 ml (mean + SD). Airway obstruction and atelectasis were relieved in 4 cases, and hemostasis was obtained in 2 cases. In 2 cases, airway dilatation and hemostasis were not obtained. BEI was more effective in the patients with polypoid or nodular tumor protruding into the airway lumen. As for adverse effects, ethanol leaks caused a severe cough in 2 cases, although they were tolerable and treatment could be continued. BEI therapy using EVIS was thought to be useful to control airway obstruction by endobronchial polypoid tumor with good cost-effectiveness and fewer adverse effects.

Phenolic antioxidants from the leaves of Corchorus olitorius L

Six phenolic antioxidative compounds [5-caffeoylquinic acid (chlorogenic acid), 3,5-dicaffeoylquinic acid, quercetin 3-galactoside, quercetin 3-glucoside, quercetin 3-(6-malonylglucoside), and quercetin 3-(6-malonylgalactoside) (tentative)] were identified from the leaves of Corchorus olitorius L. (moroheiya) by NMR and FAB-MS. The contents of these phenolic compounds, ascorbic acid, and alpha-tocopherol in C. olitorius leaves were determined, and their antioxidative activities were measured using the radical generator-initiated peroxidation of linoleic acid. The results obtained showed that 5-caffeoylquinic acid was a predominant phenolic antioxidant in C. olitorius leaves.

Brain metastasis from hepatocellular carcinoma after radical hepatectomy

Brain metastasis from hepatocellular carcinoma (HCC) is a rare, yet perplexing problem in patients with cancer. We report on 5 patients with metastasis of HCC to the brain after radical hepatectomy. Intrahepatic recurrence occurred in 3 patients, and distant metastasis to sites other than the brain was observed in 3 patients (lung, 2; bone, 1). The symptoms for brain metastasis included headache, hemiparesis, and vomiting. Hemorrhage was found in 4 of 5 patients. All patients had a single nodular lesion in the brain. The alpha-fetoprotein levels were more than 10,000 ng/ml in 4 patients. Two patients underwent surgical resection, 1 received cranial irradiation, and 2 were administered corticosteroids. The interval between diagnosis of the primary cancer and detection of brain metastasis ranged from 2 to 54 months. The mean survival period was only 3 months after diagnosis of brain metastasis. All 5 patients died of neurologic causes. Because no effective treatment for brain metastasis from HCC is available, further study is needed.

Hepatocellular carcinoma with metastasis to the rib complicated by hemothorax. An autopsy case

A 64-year old man was admitted to our hospital with multiple hepatocellular carcinoma (HCC) lesions in the liver, lung and bone. Three weeks after admission, the patient became complicated with right upper chest pain. A chest radiograph showed a marked increase in right pleural effusion. Thoracentesis demonstrated a hemothorax. Despite treatment with a continuous pleural tap and blood transfusions, the patient's clinical status worsened and he developed severe dyspnea. His right pleural effusion might be considered to be caused by a rupture of the HCC metastasis in the right 2nd rib. The patient died due to respiratory and hepatic failure 26 hours after his occurring the pleural effusion. An autopsy revealed moderately differentiated HCC in the liver, lung and bone. The HCC metastasis of the right 2nd rib was found to have torn the nearby pleura. We described a rare case in which hemothorax was caused by a ruptured rib-based HCC.

Hepatic resection with tumor thrombectomy for hepatocellular carcinoma with tumor thrombi in the major vasculatures

BACKGROUND/AIMS

It is still controversial whether surgical or non-surgical treatments should be adopted for hepatocellular carcinomas (HCC) with tumor thrombi (TT) in the major vasculatures. We evaluate the effectiveness of and the indications for hepatic resection with tumor thrombectomy for such patients.

METHODOLOGY

Seventeen patients with TT in the major vasculatures caused by HCC were enrolled. Eleven patients had Vp3 TT, 5 patients had Vv3 TT, and 1 patient had Vp3 and Vv3 TT, concurrently. Out of the 17 patients, 13 underwent hepatic resections with tumor thrombectomies and the remaining 4 received only hepatic resections without tumor thrombectomies.

RESULTS

In patients with Vp3 TT, median and mean survival times were 7.8 and 18.5 months, respectively, and 1- and 5-year survival rates were 36.4% and 18.2%, respectively. In patients with Vv3 TT, median and mean survival times were 9.9 and 8.4 months, respectively. Patients who underwent hepatic resections with tumor thrombectomies had significantly better prognoses than those who did not receive tumor thrombectomies (p=0.0039).

CONCLUSIONS

The prognosis of HCC patients with TT in the major vasculatures, who have relatively small primary tumors, good hepatic functional reserves and no distant metastases should be good, if hepatic resections with tumor thrombectomies are performed.

Ruptured duodenal varices: an autopsy case report

Bleeding from duodenal varices is a rare and life-threatening complication of cirrhosis. The diagnosis and management of this disease remains problematic. We herein report an autopsy case of a patient who suffered from recurrent bleeding from duodenal varices. A 48 year-old man with cirrhosis presented with upper gastrointestinal bleeding. He had three episodes of massive melena during the 6 months prior to admission. However, the source of bleeding was not known. Emergent endoscopy revealed jet bleeding from varices in the second to third portion of the duodenum. Endoscopic ethanol injection sclerotherapy was attempted but rebleeding occurred and the patient died.

Clinical experiences in Sakai City Hospital during the massive outbreak of enterohemorrhagic Escherichia coli O157 infections in Sakai City, 1996

In the middle of July, 1996, a massive outbreak of hemorrhagic colitis (HC) occurred among elementary schoolchildren in Sakai city. This is the most widespread outbreak of O157 infection ever experienced to our knowledge. Lunch foods supplied in the elementary schools in Sakai were contaminated by Escherichia coli (E. coli) O157. One hundred and twenty-one cases developed hemolytic uremic syndrome (HUS) from 12,680 symptomatic patients, including putative secondary infections, and three girls died during this outbreak. Sakai City Hospital is one of the core medical facilities in this community; hence, 425 children with HC were treated at the hospital. Antibiotics were used extensively on all patients. Among them, 12 children developed HUS. All 425 children, including the patients with HUS, recovered without significant sequelae. In the present paper, the clinical experiences during this massive outbreak of E. coli O157 infection in Sakai City Hospital are described.

Adjuvant hepatic arterial infusion chemotherapy after radical hepatectomy for hepatocellular carcinoma--results of long-term follow-up

BACKGROUND/AIMS

This clinical study aimed to clarify the effectiveness and indication of adjuvant hepatic arterial infusion chemotherapy (HAIC) that is performed to prevent recurrence after radical hepatectomy for hepatocellular carcinoma (HCC).

METHODOLOGY

From January 1986 to December 1992, 135 HCC patients, who tolerated curative hepatic resection in which all of the macroscopic HCC was removed, were included in this study. They were divided into two groups. One group was comprised of 68 patients who received HAIC after radical hepatectomy (HAIC (+) group), and the other group was comprised of 67 patients who received radical hepatectomy alone (HAIC (-) group). In the HAIC (+) group, an emulsion of doxorubicin (30-50 mg) and lipiodol (3-5 ml) was injected from a reservoir every 2 or 3 months for 1 year.

RESULTS

The cumulative survival rates in the HAIC (+) group (79.1%, 54.5% and 39.9% at 3, 5, and 7 years after hepatectomy, respectively) were better than those in the HAIC (-) group (69.2%, 38.1% and 26.8%, respectively) (p = 0.086). The disease-free survival rates in the HAIC (+) group (50.8%, 31.7% and 25.6% at 3, 5, and 7 years after hepatectomy, respectively) were significantly better than those in the HAIC (-) group (25.7%, 20.6% and 6.4%, respectively) (p = 0.006). This improvement was evident for 3 years after hepatectomy. The adjuvant HAIC was effective especially in patients with good liver function, whose tumor size ranged between 2.1 cm and 5 cm in diameter, and who received a minor hepatic resection.

CONCLUSIONS

Adjuvant HAIC was effective in preventing recurrence after radical hepatectomy for HCC. This treatment is especially indicated for patients with good liver function, whose tumor size ranges between 2.1 cm and 5 cm in diameter, and who have received a minor hepatic resection.

A patient with a large hepatocellular carcinoma alive 13 years after repeated transcatheter arterial chemoembolization and hepatectomy

We describe a rare case of a large hepatocellular carcinoma (HCC) in a patient who survived 13 years after repeated transcatheter arterial chemoembolization (TAE) and hepatectomy. The patient was a 41-year-old woman found in March 1985 to have a large HCC, measuring 14 x 12 cm in diameter and associated with obstruction of the main portal trunk. She underwent TAE 8 times over a period of 1 year. The serum alpha-fetoprotein level decreased from 18342 to 1871 ng/ml. The patient subsequently underwent left hepatectomy on October 9, 1986. Thirteen years after hepatectomy, the patient is being followed up on an outpatient basis and has had no evidence of recurrence.

[Lifestyle, mental health, and awareness of health among Japanese bus drivers]

To examine lifestyle, mental health and awareness of health, a self-administered questionnaire survey was performed among 751 employees of a bus company in a rural city of Japan. From 597 (79.5%) respondents, we analyzed 130 male bus drivers and age-matched 130 male clerks. The questionnaire included eleven questions about lifestyle and mental health, three questions about awareness of health, and questions on personal concern about specific parts of the body or diseases, and health information they needed. Answers for lifestyle and mental health were classified into the categories of "good" or "not good" practices recommended by Breslow and Morimoto. The results were as follows; 1) Over 80 percent of subjects of both groups had good awareness of health, but bus drivers had significantly worse lifestyle with regard to nutritional intake (p < 0.05), daily walking (p < 0.001), sports (p < 0.05), and sleeping hours (p < 0.001). 2) Bus drivers had significantly greater prevalence of concern about their cardiovascular system, esophagus and gastrointestinal system, and joints and bones than clerks (p < 0.05). 3) Bus drivers had a significantly greater need for information about nutritional intake (p < 0.001), and methods for prevention of diseases (p < 0.01). From these results, the discrepancy between awareness of health and lifestyle seen in this study, especially in food intake, walking time, sports participation, and sleep, may have resulted from the bus driver's characteristics of job, for example, long and irregular working hours. Therefore, effective guidance on health and lifestyle changes to restore balance and improve their lifestyle.

[A clinical study on the cases of ischemic colitis: comparison of clinical images based on time from onset of the disease to detection of bloody stool]

A study was performed on 28 cases of ischemic colitis. The patients were divided into three groups: Group A (9 cases with bloody stool detected within 2 hours after the onset of abdominal pain), Group B (7 cases with bloody stool detected in 2 to 6 hours), and Group C (12 cases with bloody stool detected after more than 6 hours). These cases were comparatively studied. Variables used were as follows: (1) age, (2) sex, (3) constipation, (4) vomiting, (5) peak value of WBC count (/microliter) after admission, (6) peak value of log CRP (microgram/dl), (7) presence of ulcerative lesion in endoscopic findings in acute stage. Using Group A B and C as classification variables, canonical discriminant analysis was performed. As a result, clear linearity was recognized in Group A-->B-->C, and the values (5), (6) and (7) were extracted as the corresponding variables. For these variables, significant difference was also noted in multivariate analysis of covariance. These results suggest that it is possible to predict the severity of the disease to some extent as represented by objective markers of inflammation by finding the time from onset of abdominal pain to detection of bloody stool.

Laparoscopy-assisted hepatectomy for a large tumor of the liver

We performed a laparoscopy-assisted hepatectomy on a 52-year-old woman with a large hepatic cavernous hemangioma (longest diameter, 8.5 cm). With the use of Pringle's maneuver, the left lateral segment of the liver was resected with a Cavitron ultrasonic surgical aspirator (CUSA) while lifting the abdominal wall. Postoperative hepatic dysfunction was mild and transient, resolving spontaneously early after surgery. We intend to expand the indications of this minimally invasive procedure for hepatic resection.