[Crural arterio-venous fistula due to orthopedic surgery. A report of a case]

A rare case of crural arterio-venous fistulae due to orthopedic surgery was presented. A 60-year-old female patient received a corrective fibulotomy just below the fibular head under the diagnosis of osteoarthropathy of the left knee joint 3 years ago. Intractable pain and swelling of the left leg appeared shortly after operation, probably due to deep vein thrombosis. A faint thrill on the left saphenous vein afforded a clue for detecting a co-existing arterio-venous fistula. Confirmative cine-angiography revealed a few a-v-fistulae at the level of crural trifurcation, which might have exacerbated the symptoms of deep vein thrombosis. On entering the trifurcation, which was embedded in scar tissues, there were two a-v-fistulae, originating separately from the peroneal artery and the posterior tibial artery. These fistulae were closed directly, one from the peroneal artery through the lateral approach resecting the upper one third of the fibula, and the other from the posterior tibial artery through the standard medial approach. Postoperative course was uneventful, and the swollen leg subsided rapidly with remarkable improvement of symptoms such as pain, dullness, night cramp of the calf and etc. Concerning to the medical literature on iatrogenic arterio-venous fistula due to orthopedic surgery, no similar case has been reported at least in these ten years on crural arterio-venous fistula after corrective fibulotomy.

[An analysis of community mental health services at public health centers in the Tokyo metropolitan area--services for 727 new cases during 5 years in Bunkyo-Ward]

For an overview of the community mental health services at Public Health Centers (PHCs), cases were statistically analyzed from the aspect of 3 points: the situation of psychiatric treatment at initial contact (psychiatric treatment), the person who had been living with the case at first contact (living style) and the person who contacted the PHC first (first contact person). During approximately 5 years, 463 new cases contacted the 2 PHCs in Bunkyo-Ward for consultation. Among them, 132 were under psychiatric treatment, 324 under no treatment and 7 unknown. Additionally, 264 were found to be registered on official documents, some of whom received PHC services after being listed. The percentage of schizophrenic cases in the psychiatric treatment group at first contact were higher than in the non-treatment group. More cases with psychiatric treatment were visited by PHN than without treatment. There were great differences in the first contact person among the groups classified according to living style. Especially, in the non psychiatric group, the percentage of the first contact person being other than family and relative was higher in the group who had been living alone than any other groups. Percentages of personal interview of a case, consultation by a psychiatrist in PHCs, and visiting the home of a case were different among the groups classified by psychiatric treatment, living style and first contact person. However, no difference in services outcome (total number of contacts made by a cases, relatives of cases, and other related persons), or present service utilization (continuing, discontinued, completed) among the groups classified by psychiatric treatment, living style, and first contact person was seen.

[A case report of graft-versus-host disease caused by using stored blood after aortic valve replacement]

A 61-year-old man underwent aortic valve replacement and received transfusion of 8 units of stored blood. Erythema appeared on the entire body the 12th day after operation, and was followed by high fever, elevation of liver enzymes, progressive pancytopenia, aplastic bone marrow and diarrhea. He died due to septic shock on the 19th postoperative day. Skin biopsy showed the typical features observed in graft-versus-host disease (GVHD). Based on the clinical course, skin and bone marrow biopsy, we diagnosed as post-transfusion GVHD. Therefore, even when stored blood or stored red blood cells are used, these should be irradiated and transfused through the leukocyte removal filter.

Cloning and characterization of a rat H+/peptide cotransporter mediating absorption of beta-lactam antibiotics in the intestine and kidney

A complementary DNA (cDNA) encoding the rat H+/peptide cotransporter (PepT1) was isolated, and the transport characteristics of orally active beta-lactam antibiotics were assessed by measuring uptake into Xenopus oocytes expressing the rat PepT1. The rat PepT1 cDNA encoded a 710-amino acid protein with 77% identity to the rabbit PepT1. The message for rat PepT1 was approximately 2.9 kilobases and was found predominantly in the small intestine, whereas reverse transcription-polymerase chain reaction amplification revealed that the message was expressed both in the small intestine and in the kidney cortex. The 75-kDa protein was identified by translation of in vitro synthesized transcript of rat PepT1 cDNA by use of rabbit reticulocyte lysates and by Western blot analysis with a specific antibody against the rat PepT1. When expressed in Xenopus oocytes, rat PepT1 stimulated the uptake of ceftibuten (anion) and cephradine (zwitterion) in the presence of an inward H+ gradient, and the expressed uptake was inhibited by excess dipeptides. Kinetic analysis revealed that ceftibuten has 14-fold higher affinity for the rat PepT1 than cephradine. These findings suggest that the rat PepT1 mediates H(+)-coupled uphill transport of the oral beta-lactam antibiotics across the brush-border membranes of intestinal and renal proximal tubular cells.

Chloride transport across kidney epithelia through CLC chloride channels

This review summarizes recent progress in elucidating the chloride-transporting mechanisms in kidney epithelia, focusing particularly on those which act through the newly identified chloride channels. A family of chloride channel proteins (ClC chloride channels) consisting of at least 9 members (ClC-1, 2, 3, 4, 5, 6, 7, K1 and K2) has recently been identified in mammals. Although all of these ClC channels, except for skeletal muscle-specific ClC-1, are expressed in the kidney, only ClC-K1 and K2 are kidney-specific ClC chloride channels, suggesting that they play an important role in the kidney. The functional properties and intrarenal localization of these chloride channels are summarized, and their involvement in certain tubular dysfunctions and physiological roles are discussed in this report.

[A case of hepatocellular carcinoma treated by intrahepatic arterial administration of anticancer agents: serial determination of the concentration of the chemotherapeutic agents in serum and dialysate during hemodialysis]

The concentration of adriamycin (ADR) and mitomycin C (MMC) were measured in serum and dialysate in a patient with hepatocellular carcinoma complicating chronic renal failure. ADR at a dose of 20 mg and MMC at 10 mg were administered through the hepatic artery or peripheral vein during hemodialysis. ADR and MMC became undetectable after 24 hours and 2 hours, respectively. On the other hand, while MMC was detected in dialysate, but ADR was not. Consequently, it was speculated smaller molecular weight of MMC (334.34) than that of ADR (579.99) might be responsible for the appearance of MMC in dialysate. These results suggest that hemodialysis may be effective in reducing side effects of certain anticancer agents. Serum concentration of the anticancer agents injected through hepatic artery was similar to that injected intravenously.

[Effects of obesity and weight gain during pregnancy on obstetrical factors]

The relationship between the body weight or weight gain during pregnancy and various obstetrical factors was investigated in 731 patients who delivered in San-ikukai Hospital for in the year 1986. The patients were classified into three groups according to their body weight in non-pregnant states: slender (n = 214), ordinary (n = 379) and obese (n = 138), according to the standard for "The decision diagram for the estimation of obesity and emaciation in Japanese" published in 1986 by the Ministry of Health and Welfare, Japan. Each of these groups was further divided into two groups according to the degree of weight gain during pregnancy (more or less than 15kg). Then, the duration of labor, the blood loss during delivery, the birth weight, the placental weight and the obstetrical abnormalities (prolonged labor, arrested labor, blood loss of more than 500 ml, fetal distress and toxemia of pregnancy) were investigated in these groups. The blood loss, the neonatal birth weight and the placental weight in the obese groups were much greater than those in the ordinary or the slender group (p less than 0.005). However, there was no significant difference in the duration of the labor among these groups. The incidence of obstetrical abnormalities in the obese group was significantly higher than in the ordinary or the slender group (chi 2 = 4.37, p less than 0.05, chi 2 = 5.27, p less than 0.025).(ABSTRACT TRUNCATED AT 250 WORDS)

[The phase IV studies with Estracyt in prostatic cancer]

Both anticancer and adverse reactions of Estracyt were investigated by oral administration to 200 patients with prostatic cancer. Two capsules of Estracyt were given twice a day and the administration was principally continued for more than six months. The 200 patients consisted of 68 and 132 patients who were previously untreated and treated, respectively. Thirty seven cases had been treated only with Estracyt and 132 cases also received other treatments. Seventy-five cases were of primary therapy, 71 cases were of maintenance therapy, and 27 cases were of the re-activated stage therapy and 27 cases were of other categories. In conclusion, among the 190 cases for which the due judgement of the effect was possible, Estracyt was markedly effective in 40 cases (21.1%), effective in 43 cases (22.6%), slightly effective in 38 cases (20.0%) and ineffective in 69 cases (36.3%). Adverse reactions were observed in 67 cases (33.5%), among which the administration was discontinued in 18 cases.

[Two cases of renal oncocytoma]

Two cases of renal oncocytoma are reported. These patients were a 67-year-old man and a 74-year-old man who had incidentally been indicated to have a right renal mass lesion by echography in other hospitals. In both cases, enhanced computed tomographic scan showed a low density renal mass. In selective renal angiogram of the two cases, a spoke-wheel configuration of vessels could be seen in one case, but there was no evidence of renal mass in another. Total nephrectomy was performed in each case. Two masses were pathologically diagnosed as oncocytoma, constructed of large eosinophilic cells with granular cytoplasm and small regular nuclei. These two patients have been well for more than 2 years after the surgery. These are the 25th and 26th cases of renal oncocytoma reported in Japan before December, 1988.

[Pulmonary pleomorphic carcinoma; report of 2 cases]

The 1st case was a 74-year-old male diagnosed as femoral neck fracture. Biopsy of the bone revealed metastatic adenocarcinoma. Chest computed tomography (CT) showed a mass lesion located in the right lower lobe. With a diagnosis of primary lung cancer (cT2N1M1), two-staged operation was performed. Pathological diagnosis was pleomorphic carcinoma [pT2N1M1 (OSS), stage IV]. He died 8 months after surgery due to metastasis to the thoracic spine. The 2nd case was a 80-year-old female who complained of lateral chest pain. Chest CT revealed a tumor in the right hilar region, which was diagnosed as adenocarcinoma by transbronchial lung biopsy. Only thoracic drainage was performed since metastases to the brain and the rib were demonstrated. She died 2 months after admission. Autopsy revealed pleomorphic carcinoma of the lung with metastasis to the brain, costa and mediastinal lymph nodes.

Fat and fish intake and asthma in Japanese women: baseline data from the Osaka Maternal and Child Health Study

OBJECTIVE

It remains controversial whether the intake of n-3 polyunsaturated fatty acids and fish is preventive against asthma. This cross-sectional study investigated the relationship between fat and fish intake and the prevalence of asthma using baseline data from a prospective study.

DESIGN

The subjects were 1002 pregnant Japanese females. A diet history questionnaire was used to assess dietary habits. Current asthma and asthma after age 18 were defined as present if subjects had been treated with medications at some time in the previous 12 months and after reaching the age of 18, respectively.

RESULTS

Fish consumption was independently associated with a decreased prevalence of asthma after age 18 and current asthma. A significant inverse relationship was observed between the ratio of n-3 to n-6 polyunsaturated fatty acid intake and the prevalence of current asthma, but not asthma after age 18. Intake of total fat, saturated, monounsaturated, n-3 polyunsaturated and n-6 polyunsaturated fatty acids, cholesterol, meat, eggs or dairy products was not evidently related to either outcome for asthma.

CONCLUSION

Our results suggest that fish consumption and the high ratio of n-3 to n-6 polyunsaturated fatty acid intake may be associated with a reduced prevalence of asthma in young female Japanese adults.

Variation of microvascular blood flow augmentation--supercharge in esophageal and pharyngeal reconstruction

AIM OF THE STUDY

A gastric tube is commonly used in thoracic esophageal reconstruction. When a gastric tube is not available, pedicled jejunum transfer and colonic interposition are alternative methods. Oral end of the reconstructed esophagus occasionally has poor blood flow and may result in partial necrosis of the oral segment. We performed additional microvascular blood flow augmentation, the "supercharge" technique, to improve a blood flow circulation in the oral segment of the reconstructed esophagus.

METHODS

A series of 86 esophageal reconstructions with microvascular blood flow augmentation using the "supercharge" technique were performed. Reconstructive methods included a gastric tube in five patients, a gastric tube combined with a free jejunual graft in one, an elongated gastric tube in eight, a pedicled colonic interposition in 22, and a pedicled jejunum in 50. Recipient vessels were used in neck or chest region.

RESULTS

The color and blood flow of the transferred intestine appeared greatly improved after microvascular blood flow augmentation. Thrombosis was noticed in three patients during the surgery, and all thrombosies were salvaged by re-anastomosis. There were only three patients with partial graft necrosis of oral segment, two patients with anastomotic leakage, one anastomotic stricture.

CONCLUSIONS

Augmentation of microvascular blood flow by this "supercharge" technique can be expected to reduce the risk of leakage and partial necrosis of the transferred intestine. This technique contributes to the successful reconstruction of esophageal defect.