Aberrant left gastric vein directly draining into left portal venous system. A case report

A 66-year-old man with early gastric cancer and liver cirrhosis was diagnosed by preoperative angiography as having an aberrant left gastric vein communicating directly with the left lateral portal vein system. This communication was confirmed during operation for the gastric cancer. Our report is the first of an aberrant left gastric vein showing direct communication with the left portal vein system.

Terminal 22q deletion associated with a partial deficiency of arylsulphatase A

A 7 month old girl with psychomotor retardation, hypotonia, and minor malformations was found to have a terminal deletion of the long arm of chromosome 22, del(22)(q13.31). The partial deficiency of arylsulphatase A (ARSA) and the normal level of NADH diaphorase 1 (DIA1) suggests that the ARSA locus can be regionally assigned to 22q13.31----qter and the DIA1 locus can be excluded from the same segment. This report is the third published case with a terminal 22q deletion.

A newly identified null allelic mutation in the human lipoprotein lipase (LPL) gene of a compound heterozygote with familial LPL deficiency

In a Japanese patient with familial LPL deficiency, a new null allelic mutation, one base pair deletion at nucleotide position 916 was identified in exon 5 of one allele. In exon 3 of the other allele, we found the same nonsense mutation as we described previously in other Japanese kindreds. For the deletional mutant allele, we developed a simple detection method and constructed the DNA haplotype.

De novo complex chromosome rearrangement in identical twins with multiple congenital anomalies

A de novo and apparently balanced complex chromosome rearrangement (CCR) was found in monozygotic (MZ) twin infants with multiple congenital anomalies. The rearrangement involved 4 chromosomes with 6 breakpoints including 2p23, 2q13, 2q21.1, 3p23, 11q13.1, and 12q24.1. This seems to be the first report of a CCR in MZ twins. The relationship between this chromosome abnormality and MZ twinning is discussed.

Unique karyotypes in two patients with Prader-Willi syndrome

A physical disruption of the Prader-Willi syndrome (PWS) chromosome region is thought to cause PWS. We describe 2 girls with PWS phenotype, who had unique chromosome 15 abnormalities. The first patient showed mosaicism: 45,XX,t(15;15)(qter----p11.1::q11.200----qter)/46,XX,t(15;15)(qter----p1 1.1::q 11.200----qter), +mar. The band 15q11.2 apparently remained intact in the t(15;15) chromosome, and the mar chromosome was considered as r(15) (p11.1q11.1). The second patient had a karyotype of 47,XX,del(15)(q11.200----q11.207), +idic (15)(pter----q11.1::q11.1----pter). The complex breakage and reunion involving the 15q11.2 regions of the father's homologous chromosomes 15 at meiosis appeared to have resulted in the idic(15) and the del(15) chromosomes. These cytogenetic findings suggest that the PWS chromosome region may be localized on the very proximal portion of band 15q11.2.

Diagnostic validity of fecal occult blood tests for detecting gastroenterological cancers

In order to estimate the diagnostic validity of chemical fecal occult blood tests, i.e. orthotolidine (Shionogi A) and guajac (Shionogi B) slides for detecting cancers of the esophagus, stomach and colorectum, the authors followed up all the examinees (n = 3,449) of comprehensive medical check-ups at the Center for Adult Diseases, Osaka, by means of record linkage to the Osaka Cancer Registry's files. Then, diagnostic validity was calculated based on the results of two years' follow-up. Sensitivity for the respective cancers was 20.0%, 11.8% and 62.5% for Shionogi A, and 20.0%, 5.9% and 43.8% for Shionogi B slides. Likelihood ratio for the respective cancers was 1.4, 0.8 and 4.5 for Shionogi A, and 3.3, 1.0 and 7.5 for Shionogi B. Specificity was analogous among the three cancer sites, being 86% for Shionogi A and 94% for Shionogi B. These results suggest that the diagnostic validity of chemical occult blood tests for detecting cancers of the esophagus and the stomach is very poor, and therefore imply that close examinations of these sites for screening positives is unnecessary in mass screenings for colorectal cancer.

A case of small round cell tumor of the thoracopulmonary region with myogenic and neurogenic elements

We here report a unique case of a young boy with an intrathoracic tumor which consisted of neurogenic and myogenic elements. The initial pathological diagnosis was alveolar rhabdomyosarcoma. The tumor tissue from surgical resection was composed of three parts, each showing a different histological appearance, i.e. a monotonous small cell area, an alveolar area, and an area consisting of pleomorphic rhabdomyoblasts. The small round cells in the monotonous area were immunoreactive with the antibodies for Leu7, neuron-specific enolase (NSE), neurofilament proteins (NFP), and beta 2 microglobulin, but not with the antibody for desmin. These cells also had dense core granules. The tumor cells in the alveolar area were immunoreactive with the antibodies for Leu7 and desmin, but not with the antibody for NFP. Pleomorphic rhabdomyoblasts were immunoreactive with the antibody for desmin, but not with the antibodies for Leu7 and NFP. These findings imply that this tumor consisted of neurogenic and myogenic elements and is considered to be a special type of rhabdomyosarcoma.

Detection and quantitative assessment of a Vibrio cholerae O1 species in several foods by a novel enzyme immunoassay

A selected antibody enzyme immunoassay (SAEIA) for the general detection of Vibrio cholerae O1 species has been developed using the immunological reagents of a rabbit antiserum specific for V. cholerae O1 classical Inaba 569B and immobilized cell fragments of V. cholerae O1 El Tor 85P6, and beta-D-galactosidase-labeled goat anti-rabbit immunoglobulin G as tracer. The SAEIA was specific for V. cholerae O1 species and showed low cross-reaction values to other microorganism species tested including Vibrio parahaemolyticus. The detection limit of the SAEIA was 4,500 cells per assay for all the 13 strains of V. cholerae O1 examined. Quantitative comparison on the growth of the El Tor 85P4 in several foods cultured for 24 hr were studied using the SAEIA. Preceding the experiments, little inhibition of every food homogenate for the measurement of the SAEIA was first demonstrated and then the homogenate was directly used for an assay sample. The interaction of the growth of Escherichia coli to that of V. cholerae O1 in a food was also found to be little under the mixed culturing of both bacteria using the SAEIA.

The detection of myocardial ischemia by thallium-201 myocardial scintigraphy in patients with multiple coronary arterioventricular connections

The question of whether myocardial ischemia could be induced in 5 patients with multiple coronary arterioventricular connections by thallium-201 (201Tl) exercise stress myocardial scintigraphy was investigated. Both ST-T changes on ECG and transient myocardial perfusion defects in myocardial scintigrams were observed in 2 patients (40%). In previous reports, all multiple coronary arterioventricular connections, which were shown in angiograms, have been regarded as either Thebesian veins or embryonic sinusoids. However, it is unlikely that Thebesian veins cause myocardial ischemia judging from anatomy. If the vessels cause myocardial ischemia, they should be regarded as multiple coronary arterioventricular fistula. Angiography itself cannot differentiate multiple coronary arterioventricular fistula from Thebesian veins or remnants of embryonic sinusoids. Exercise stress myocardial scintigraphy has a high potential to detect myocardial ischemia due to intracoronary steal. Exercise stress myocardial scintigraphy was used to demonstrate myocardial ischemia in multiple coronary arterioventricular connections. It is concluded that exercise stress myocardial scintigraphy is a reliable test to differentiate multiple coronary arterioventricular fistula from Thebesian veins or remnants of embryonic sinusoids in clinical practice.

Superior vena cava flow and tricuspid anular motion after cardioversion of atrial fibrillation, and role of right atrial relaxation on systolic venous return

To determine whether atrial relaxation or systolic descent of the tricuspid anulus is the predominant factor determining systolic venous return, 22 patients with atrial fibrillation were studied. Venous return (i.e., superior vena cava (SVC) flow) was measured using pulsed Doppler echocardiography. Systolic descent of the tricuspid anulus (i.e., total excursion of tricuspid anulus during systole) was also measured using echocardiography. Serial examinations were performed before and after cardioversion of atrial fibrillation in 15 patients. In 11 patients, both the total excursion of the tricuspid anulus and SVC flow were examined in relation to the ratio of the preceding to the pre-preceding RR interval (R2/R1). Systolic forward flow of SVC increased as the ratio of late diastolic to total excursion of the tricuspid anulus (i.e., right atrial systolic function) increased. It correlated significantly with the ratio of late diastolic to total excursion of the tricuspid anulus but not with total excursion. Total excursion of the tricuspid anulus correlated significantly with R2/R1, but systolic forward flow of SVC did not. These results indicate that atrial relaxation rather than systolic descent of the tricuspid anulus was the predominant factor determining systolic forward flow in the SVC.

Vitamin D receptors in heart: effects on atrial natriuretic factor

We report that receptors for vitamin D exist in distinct regions of the heart in female and male mice, predominantly in the right atrium where most of the cardial atrial natriuretic peptide (ANF) is produced. Tritiated 1,25-dihydroxyvitamin D3 (1,25-D3, vitamin D, soltriol) and ANF are colocalized in nuclei and cytoplasm respectively in identical cardiomyocytes. Changes of ANF tissue and blood levels under dietary deficiency and treatment with 1,25-D3 suggest direct genomic actions of vitamin D on myoendocrine cells of the atrium for the regulation of ANF manufacture and secretion. These results were obtained by combining thaw-mount autoradiography with immunocytochemistry using tritiated 1,25-D3 and an antibody against rat ANF. This antibody was also used in a radioimmunoassay to determine atrial natriuretic factor in plasma, atria and ventricles of normal or vitamin D-deficient mice.

Angina pectoris due to possible vasospasm of small coronary arteries

Recently, the presence of vasospasm in small coronary arteries is speculated in animals and humans. A 40-year-old female patient complained of chest pain at rest. Left ventriculogram showed normal wall motions. Left and right coronary arteries were also normal. After methylergometrine maleate was selectively administered to a right coronary artery, she complained of chest pain, and ST-segment elevation was detected in leads II, III, and aVF of ECG. Right coronary arteriography was performed immediately, but no coronary stenosis was found. The next day, methylergometrine maleate was again administered intravenously and the patient complained of chest pain, but no ischemic changes were observed in ECG. Thallium-201 myocardial scintigraphy followed immediately. Apical perfusion defect was detected in stress image. In the delayed image, it showed complete redistribution. Three days later, catheterization and scintigraphy were performed at the same time. When methylergometrine maleate was administered to the left coronary artery, she complained of chest pain within a few minutes of the injection; however, ECG remained unchanged. 201Tl myocardial scintigraphy was performed immediately. In the stress image, it showed apical perfusion defect as shown in the intravenous methylergometrine maleate injection study. It also showed complete redistribution in the delayed image. Apical perfusion defect can be attributed to myocardial ischemia of left coronary artery, which are too small to be detected by conventional coronary arteriography. Vasospasm in small coronary arteries may be involved in this phenomenon.

Pharmacokinetics of pirarubicin in pediatric patients

The pharmacokinetics of pirarubicin and its active metabolite, doxorubicin, were studied after intravenous administration of pirarubicin (25-45 mg/m2) to ten pediatric patients. The concentration-time curves of pirarubicin in both blood and plasma showed representative biphasic patterns. Pirarubicin concentrations decreased rapidly from 0.5 to 2 h after administration and then decreased slowly until 24 h in all subjects. High concentrations of the metabolite, doxorubicin, were detected at 0.5 h after administration of pirarubicin which decreased gradually until 24 h. The area under the concentration-time curve from 0 to 24 h (AUC0-24) of pirarubicin and doxorubicin in blood were 3-4 times higher than those in plasma, suggesting that these drugs had a high affinity for blood cells. The AUC0-24 ratio of doxorubicin to pirarubicin in plasma was calculated to be 0.441. It might be indicated that not only pirarubicin but also doxorubicin are responsible for the therapeutic efficacy and the incidence of toxicity of pirarubicin. The pharmacokinetics of pirarubicin in pediatric patients was fundamentally similar to that of adults, but it was recognized that considerable interindividual variation in the disposition of pirarubicin and doxorubicin exists.

Sideroblastic anemia showing unique response to pyridoxine

We treated and followed up for 6 years a patient with pyridoxine-responsive sideroblastic anemia. The patient was a boy age 1 year and 9 months, who was diagnosed on the basis of peripheral red cell morphology and an increased number of sideroblasts in the bone marrow. Bone marrow erythroblasts showed a marked reduction of delta-aminolevulinic acid synthase (ALA-S) activity. The response of the patient to pyridoxine and its active form, pyridoxal phosphate, was unique. After the first course of pyridoxal phosphate therapy (300 to 500 mg/day i.v. for 4 days), all hematological data were restored to normal and remained normal for 29 months without the further administration of pyridoxal phosphate. The second course of pyridoxal phosphate therapy (500 mg/day i.v. for 2 days) was effective for 6 months. The third, fourth, and fifth courses of the therapy consisted of daily oral pyridoxine hydrochloride at a dose of 180 mg/day for 4 to 6 weeks, and the respective periods of hematological remission were 7, 12, and greater than 18 months. These observations suggest the presence of a complicated ALA-S activating or inactivating system, or both, in our patient.

[Change of renal function immediately after angiography]

Abdominal angiography using ioxaglate (3.0-4.5 ml/kg) was performed in 10 patients with normal renal function. Ccr, FENa, CH2O were compared before and immediately after angiography. There was no significant change in Ccr and CH2O level, while FENa increased remarkably after angiography. This study suggested that the osmotic diuresis and the proximal tubular stress were induced by administrated low osmolality contrast material during conventional abdominal angiography.

Serum carnitine and nutritional status in children treated with continuous ambulatory peritoneal dialysis

The serum carnitine (total carnitine), total protein, amino acid, and triglyceride levels were determined in children on continuous ambulatory peritoneal dialysis (CAPD). Compared with levels in controls, serum carnitine levels were significantly decreased in patients on CAPD for more than 4 months, while those of patients on CAPD for 1-3 months were not decreased. Patients on CAPD for more than 4 months also showed lower serum total protein levels than in normal controls. The mean triglyceride levels in patients on CAPD for both 1-3 months and more than 4 months were higher than those in normal controls. Among the amino acids, the serum levels of tryptophan, isoleucine, leucine, tyrosine, valine, serine, and asparagine were significantly lower in patients treated with CAPD than in normal controls, whereas the levels of other amino acids were either increased or not changed. Isoleucine and leucine levels showed a strong correlation with serum carnitine. Our data suggest that malnutrition plays a role in the decrease of serum carnitine levels in patients receiving CAPD.

Natural history of colorectal polyps and the effect of polypectomy on occurrence of subsequent cancer

To elucidate the natural history of colorectal polyps and to observe the influence of endoscopic polypectomy on the incidence of colorectal cancer, we conducted a retrospective cohort study of all patients who had undergone colonoscopic examination at the Center for Adult Diseases, Osaka, between April 1974 and December 1985. The study subjects consisted of a control group (760 non-polyp patients) and a polyp group (648 polyp patients, including 136 treated by polypectomy at the initial examination). These subjects were followed up until the end of 1987 by record linkage with the Osaka Cancer Registry's file to observe the occurrence of colorectal cancer. The O/E (observed/expected numbers derived from the general population) was 5.1 (95% confidence interval = 2.5-9.4) and 1.0 (0.1-3.6) for the polyp and control group, respectively. When subjects in the polyp group were categorized into polypectomy and non-polypectomy sub-groups, the O/E was 2.3 (0.1-12.6) and 8.0 (3.4-15.8) respectively. The relative risk of undergoing polypectomy to developing subsequent cancer was estimated at 0.3 (0.1-2.1). These results suggest an increased risk of developing cancer among polyp patients and the possibility of prophylactic effect of polypectomy against subsequent cancer. A large-scale and long-term follow-up study is required to confirm these findings.

Distribution of progestin-binding cells in estrogen-treated and untreated neonatal mouse uterus and oviduct: autoradiographic study with [125I]progestin

Progestin-binding sites in uteri and oviducts of estrogen-treated and untreated 8-day-old mice were studied by thaw-mount autoradiography with [125I]progestin. In the untreated uteri, nuclear concentration of radiolabelled progestin was observed in all tissues of the uterus, with strongest nuclear labelling in luminal and glandular epithelia and in stroma. In the estrogen-treated uteri, the degree of labelling was markedly augmented in stroma and muscle, but much reduced in the luminal and glandular epithelia, compared to untreated uteri. In untreated oviducts, nuclear labelling was observed in stroma and muscle in all regions and in epithelium in the isthmic and uterine regions. The epithelium in infundibular and ampullar regions was only scarcely labelled. The estrogen-treatment augmented the labelling in stroma and muscle of the oviduct as in the uterus, but the labelling in epithelium was not affected. These results indicate that estrogen-treatment induces progesterone receptor differentially among tissue compartments both in the uterus and oviduct.

Sites of action of soltriol (vitamin D) in hamster spleen, thymus, and lymph node, studied by autoradiography

Siberian hamsters (Photopus sungorus) were injected with 3H dihydroxycholecalciferol (vitamin D, soltriol). Autoradiograms of spleen, thymus, and lymph nodes revealed nuclear concentration of the hormone in a select population of cells in all of these organs. In the spleen, labeled cells were abundant in the red pulp, but sparse in the white pulp. In the periarterial lymphatic sheath (PALS) labeled cells were found predominantly at the outer rim, with a few scattered labeled cells in the inner PALS and in the marginal zone. Lymphocytes, including pyronin-positive plasma cells, did not display nuclear labeling. In the red pulp, some of the labeled cells contained pigmented inclusions in the cytoplasm, while most of the labeled cells did not appear phagocytic under the conditions of the experiment. In the thymus, labeled cells were most numerous in the medulla, but sparse in the cortex. Many of the thymic target cells were larger than the unlabeled lymphocytes, with a large and pale nucleus, sometimes containing a distinct nucleous, and with large and dendritic cytoplasm, having the appearance and distribution of epithelio-reticular cells. In lymph nodes, scattered labeled cells were conspicuous in or near the subcapsular sinus, while other cells did not concentrate radioactivity in their nuclei. The results indicate that nuclear receptors and direct genomic actions for soltriol exist in certain cell populations of lymphatic tissues that probably include reticular cells and a subpopulation of macrophages. These target cells may mediate effects of the steroid on lymphocytes that appear to have no or only very low numbers of nuclear receptors.

Superior vena cava syndrome as a complication of DDD pacemaker implantation

A 75-year-old man was admitted to our hospital because of swelling of the face and neck 6 months after implantation of a two-chamber pacemaker. Digital subtraction angiography showed total occlusion of the superior vena cava vein and well-developed collateral channels. After thrombolytic therapy, facial swelling disappeared. Digital subtraction angiography performed after thrombolytic therapy revealed a recanalization of the superior vena cava.

Estimation of validity of mass screening program for gastric cancer in Osaka, Japan

To assess the validity of mass screening tests for gastric cancer conducted with three types of radiographic techniques, i.e., photofluorography by a mirror camera, photofluorography by an image intensifier, and direct radiography, 105,122 persons who underwent a total of 272,667 screening tests during 1970 through 1982 were followed through December 31, 1983 by means of a record linkage to the Osaka Cancer Registry, Osaka, Japan. The results of 1 year's follow-up from screening were defined as the gold standard and test performance values were calculated. Sensitivity of screening with photofluorography by a mirror camera, photofluorography by an image intensifier, and direct radiography was 90%, 89%, and 91%, and specificity was 86%, 92%, and 91%, respectively. The receiver operating characteristics curve for screening with photofluorography by an image intensifier resembled that for direct radiography and these two curves were located somewhat to the left of the curve for screening with photofluorography by a mirror camera. The authors conclude that the validity of screening with photofluorography by an image intensifier is almost equivalent to that of screening with direct radiography and both are superior to that of screening with photofluorography by a mirror camera.

Close correlation between the distribution of tenascin and that of actin filaments in the mouse urethral mesenchyme during active morphogenesis

The distribution of tenascin, an extracellular matrix glycoprotein, and that of actin filaments were studied in the developing urethra of mouse embryos by antitenascin immunofluorescent and rhodamine-phalloidin staining. Tenascin appeared transiently in the urethral mesenchyme at the site of active morphogenesis in which the urethral epithelium separated from the surface epithelia of the glans and prepuce, being tubular, and the bilateral mesenchymes lining the preexisting urethral epithelium were seamed together in the ventral side of the tubular urethra immediately after the epithelial separation. The spatially and temporally restricted distribution of tenascin corresponded well to that of mesenchymal cells which possessed many actin filaments. These observations suggest that tenascin is involved in the cytoskeletal organization of mesenchymal cells in the active phase of morphogenesis.