Advanced primary non-Hodgkin's lymphoma of the small intestine in childhood: report of four cases

Primary non-Hodgkin's lymphoma of the small intestine (PLI) is an uncommon malignancy in childhood which carries a poor prognosis. Consideration of the possible diagnosis of PLI is important when children have vague abdominal symptoms, since thoughtful multidisciplinary treatment can result in a better prognosis. This paper reports the cases of four children who have presented to our hospital since 1985 with advanced stage III or IV PLI. All the children had a huge abdominal mass but none of them had complete intestinal obstruction. Regarding the diagnosis, ultrasonography frequently reveals a hypoechoic thickening of the intestinal wall with dilated intestinal loops. A delayed primary or second-look operation may be the treatment of choice following adequate chemotherapy, while total parenteral nutritional support may prevent gastrointestinal complications. Three of the four patients have been in complete remission for 2 to 4 1/2 years since their initial treatment.

Clinical profile and outcome of primary hyperparathyroidism accompanied by chronic renal failure

We encountered 5 cases of primary hyperparathyroidism (PHPT) accompanied by chronic renal failure over the past 4 years. Neither hypocalcemia nor hyperphosphatemia was found in the past records. The parathyroid hormone (PTH) levels in these cases were extraordinarily higher than those in usual patients suffering from renal failure. The manifestation of PHPT-developed insidiously together with the decline of renal function. Serum 1,25(OH)2D3 levels were lower than normal range in all cases, and which in turn might accelerate the progression of PHPT in a similar way as the development of secondary hyperparathyroidism. Parathyroidectomy (PTX) was done successfully in 4 cases, and the pathology of the biggest gland was adenoma but hyperplasia was found in other glands simultaneously. These results revealed the polymorphism of parathyroid glands in case of complication with renal failure. Furthermore, the interruption of postoperative 1 alpha(OH)D3 treatment induced the relapse of hyperparathyroidism (HPT). The case which refused PTX was treated by oral pulse therapy with 1,25(OH)2D3. The calcium/intact PTH sigmoidal curve examined 3 years later revealed that the set point shifted to right and upward despite therapy. It suggested that functional parathyroid mass became larger and the sensitivity to calcium became less under continuous stimuli on parathyroid glands. According to these results, PHPT accompanying with renal failure is resistant to medical therapy, and surgical treatment is a possibility. In this occasion, total PTX with autograft transplantation is better than simple adenectomy because even the glands not responsible to clinical manifestation of PHPT can have some pathological abnormalities.(ABSTRACT TRUNCATED AT 250 WORDS)

Surgical treatment of arrhythmogenic right ventricular dysplasia: long-term outcome

Eight male patients ranging from 15 to 51 years old (mean age, 36.3 years) underwent surgical treatment of ventricular tachycardia (VT) associated with arrhythmogenic right ventricular dysplasia. One patient had an associated left ventricular aneurysm. The earliest activation site was detected for 15 lesions, and delayed potentials were recorded during sinus rhythm in all patients. On the basis of the epicardial mapping, the origins of the VT foci in the right ventricle were resected. Cryoablation on the surrounding myocardium was performed. There were no surgical deaths or postoperative fatal complications. During long-term follow-up, there has been no recurrence of VT and no congestive heart failure in the 6 patients without left ventricular involvement. The 2 patients with LV involvement died late of either congestive heart failure or development of VT originating from the left ventricle. In conclusion, a surgical approach consisting of myocardial excision and cryocoagulation offers a curative treatment of VT associated with arrhythmogenic right ventricular dysplasia and yields excellent long-term results when the VT origin is well identified in the right ventricle.

Why do I stand against the movement for cardiac transplantation in Japan?

In order to clarify the reason the author stands against the movement for cardiac transplantation in Japan, certain crucial differences between death judged by the classical criteria and so-called brain death are briefly discussed, followed by the presentation of three major arguments. First, various problems associated with postoperative care of organ recipients are delineated, particularly side effects of immunosuppressive drugs and long term prognosis with reference of life expectancy as well as quality of life. Second, it is emphasized that transplantation involves prejudice and inequality, since the number of potential organ recipients far exceeds that of donors and only a small portion of transplant candidates can actually receive the organs while others have to wait in vain. Third, once organ transplantation from brain dead patients is allowed, numerous ethical and social problems would arise including an arbitrary expansion of the criteria for brain death, selection of donors and recipients by taking non-medial factors into consideration, development of organ commerce leading to the involvement of organized crime, and the birth of a trend in transplant candidates to wish for an early death of histocompatible donors. Finally, it is pointed out that we must give serious thought to the danger of "from neck down" transplantation creating a new person from two bodies (which is a brain transplant in actuality) in the future, since the difference between such a procedure and the multiorgan transplantation presently practiced in many developed countries is only quantitative and one cannot find a logical reason to ban the former while retaining the latter.

[Pharmacokinetic and clinical evaluation of cefozopran in the pediatric field]

We conducted a pharmacokinetic and clinical studies on cefozopran (CZOP), a new cephem antibiotic for injection. 1. Changes in serum levels of the agent after intravenous bolus injection at a dose of 20 mg/kg to 4 pediatric patients (age: 5-10 years) were observed. The levels at 30 minutes after injection were 32.9-73.4 micrograms/ml average: 55.4 +/- 18.1 micrograms/ml), then the levels gradually decreased with half-lives of 1.67-2.24 hours (average: 1.85 +/- 0.27 hours) to 0.8-1.8 micrograms/ml (average: 1.2 +/- 0.4 micrograms/ml) at 8 hours after injections. Urinary levels reached at the maximum as, 1,773-3,450 micrograms/ml (average: 2,693 +/- 698 micrograms/ml) within 0-2 hours or 2-4 hours after injection, and recovery rates from urine in the first 8 hours after injection were 55.4-91.1% (average: 71.6 +/- 16.8%). 2. Transition to cerebrospinal fluid was examined in cases with purulent meningitis and aseptic meningoencephalitis. In the meningitis case, the level in cerebrospinal fluid 1 hour after administration was 8.8 micrograms/ml in the second day after the start of 4 times a day intravenous bolus injections with 42.5 mg/kg at each dose; The ratio of the drug level in cerebrospinal fluid to that in serum was 24.0%. In the meningoencephalitis, the levels in cerebrospinal fluid 1 hour after administrations were 1.1 micrograms/ml and 1.5 micrograms/ml in the second and the sixth days respectively, after the start of 4 times a day intravenous bolus injections with 50 mg/kg at each dose; the ratio of the levels in cerebrospinal fluid to those in sera were 0.93% and 2.41% respectively, at the second and the sixth day. 3. CZOP was clinically evaluated in 29 cases (ages: 2 months to 15 years) of pediatric infectious diseases. The agent was administered 3-4 times daily with 17-50 mg/kg at each dose, continued for 5-13 days. Total doses were 1.95-24.05 g. Clinical efficacy was evaluated in a total of 28 cases (1 case of purulent meningitis, 2 cases of acute purulent tonsillitis, 20 cases of acute pneumonia, 3 cases of urinary tract infections, 1 case of purulent lymphadenitis in cervical part and 1 case of cellulitis in face); The efficacies were "excellent" in 22 cases and "good" in 6 cases.(ABSTRACT TRUNCATED AT 400 WORDS)

Molecular cloning and functional expression of a cDNA encoding the human V1b vasopressin receptor

Arginine vasopressin modulates the release of adrenocorticotropic hormone, beta-endorphin, and prolactin from the anterior pituitary. Release is mediated by the V1b receptor through the mobilization of intracellular Ca2+ by phosphatidylinositol hydrolysis. In contrast to its well characterized peripheral actions, such as antidiuresis, contraction of vascular smooth muscle, and stimulation of hepatic glycogenolysis, the exact site and mechanism of vasopressin action in the pituitary remain unclear. This is largely due to a lack of information on the molecular identity and exact localization of the V1b receptor. This lack prompted us to try to isolate this receptor subtype. Here we report the molecular cloning and functional expression of a complementary DNA encoding the human V1b receptor. The deduced 424-amino acid sequence of the receptor has highest overall homology with the V1a, V2, and oxytocin receptors, with homologies of 45, 39, and 45%, respectively. The receptor expressed in COS-1 cells has a single binding site for arginine vasopressin with a Kd of 0.17 +/- 0.04 nM. It binds various agonists and antagonists of vasopressin with affinities distinct from those of V1a and V2 receptors but consistent with those anticipated for the V1b receptor on the basis of the pharmacological studies. Furthermore, arginine vasopressin evoked calcium-dependent chloride current in Xenopus oocytes transfected with the receptor, which was not affected by a V1a/V2 antagonist. In contrast, the current evoked in oocytes transfected with V1a receptor was abolished by the antagonist. Northern blot analysis revealed that the receptor expression is restricted to the pituitary. These data clearly indicate that the cloned cDNA encodes the V1b receptor.

Galanin-containing neurons in the paraventricular nucleus: a neurochemical marker for fat ingestion and body weight gain

The physiological function of the peptide galanin (Gal) remains to be established. It is known to exist in high concentrations within the hypothalamus and to modulate the secretion of specific hormones, as well as to potentiate food consumption. Our study provides evidence for an essential function of neuronal Gal, within a specific hypothalamic area, in stimulating the behavioral process of fat ingestion and body weight gain. Through analyses of peptide levels via RIA and of gene expression via in situ hybridization, a close positive association is established between Gal in the paraventricular nucleus (PVN), particularly its midlateral region, and fat ingestion. No such relationship is detected for Gal in other brain areas or between PVN Gal and ingestion of carbohydrate or protein, supporting the behavioral and anatomical specificity of this relationship. Through PVN injection studies with antisense oligonucleotides to Gal mRNA, a dramatic decline in fat ingestion and body weight suggests that endogenous Gal contributes to the natural appetite for fat. Thus, Gal in the PVN is identified as a neurochemical marker for fat ingestion and, consequently, body weight gain.

GABAergic system inducing hyperthermia in the rat preoptic area: its independence of prostaglandin E2 system

Brain temperature of conscious freely moving rats was recorded during perfusion of the preoptic area (POA) with neuroactive compounds using the microdialysis technique. Unilateral perfusion of the POA with the sodium channel blocking agent, tetrodotoxin (1 microM), induced a pronounced hyperthermia. Of the neuroactive compounds examined, the greatest thermogenic response to local perfusion of the POA was elicited by the GABAergic agonist, muscimol. Muscimol (10, 20 and 100 microM) exhibited a dose-dependent and reversible hyperthermia. This hyperthermia was attenuated by co-perfusion with the GABAergic antagonist, bicuculline (10 microM). Muscimol-induced hyperthermia was independent of prostaglandin biosynthesis, and additive with prostaglandin E2 (10 microM)-induced hyperthermia. Prostaglandin E2-induced hyperthermia was not affected by co-perfusion with bicuculline. These data suggest the existence of two independent neurochemical systems for genesis of hyperthermia colocalized within the POA.

Antianxiety actions of Ca2+ channel antagonists with Vogel-type conflict test in rats

We examined the effects of various derivatives of Ca2+ channel antagonists in a modified rat Vogel-type conflict model. Flunarizine (10 and 20 mg/kg), nicardipine (20 mg/kg), and verapamil (20 mg/kg), given as single i.p. injections, significantly increased punished lickings by 50-110%. Chronic administration of diltiazem, at 20 mg/kg i.p. for 8 days, a dose ineffective with a single i.p. injection, produced a significant anticonflict action. The possibility that Ca2+ channel antagonists have anxiolytic action should be considered.

Early detection of successful coronary reperfusion based on serum myoglobin concentration: comparison with serum creatine kinase isoenzyme MB activity

The usefulness of serum myoglobin (Mb) concentration for early detection of successful reperfusion was compared with that of creatine kinase isoenzyme MB (CKMB) activity in 49 patients with acute myocardial infarction. To determine accurately the time of reperfusion, we performed coronary angiography every 5 minutes during reperfusion therapy. Reperfusion was obtained in 32 patients (reperfused group) but not in 17 patients (nonreperfused group) until 60 minutes after the initiation of reperfusion therapy. Blood samples were taken before and 15, 30, and 60 minutes after the angiographic confirmation of reperfusion in the reperfused group. In the nonreperfused group, samples were taken before and 15, 30, and 60 minutes after the initiation of treatment. We calculated the Mb ratio (value after reperfusion or treatment initiation to value before) and CKMB ratio (value after to value before). When values > 2.4 for the Mb ratio or > 2.0 for the CKMB ratio were used as the criteria for reperfusion within 60 minutes after initiation of treatment, the sensitivities were 91% and 56% at 15 minutes after reperfusion, 97% and 84% at 30 minutes, and 100% and 100% at 60 minutes, respectively. For each ratio the specificity of detection was 100% at all times evaluated. Thus the Mb ratio accurately detected the success of reperfusion as early as 15 minutes after reperfusion and may be more useful than the CKMB ratio for detecting the success of reperfusion within 30 minutes.

[A case of surgical treatment of Swyer-James syndrome]

Swyer-James syndrome was usually diagnosed on the past history and the radiologic features, and almost all the cases were followed by the conservative therapy. Therefore, the examination of the pathologic features was rare. We recently experienced a patient with Swyer-James syndrome, who had a history of respiratory infection from his childhood onward and whose chest radiograph revealed hyperlucency of the right lower lung field. A standard right middle and lower lobectomy was performed. Histological examination of the resected specimens revealed hypoplasia of alveoli and pulmonary artery.

Nonkallikrein arginine endopeptidase in the human submaxillary gland: purification and characterization of the enzyme

The two major species of arginine endopeptidase present in the soluble fraction of human submaxillary gland are glandular kallikrein and another enzyme tentatively named nonkallikrein arginine endopeptidase. In this study, we purified the latter enzyme to homogeneity and examined its catalytic properties. The newly found enzyme was clearly distinguishable from human tissue kallikrein in its molecular nature, action toward various synthetic substrates, and kinin-generated activity. The specificity of the action of the enzyme was further investigated using various basic amino acid-containing peptides as model substrates. HPLC analysis of peptide fragments produced, followed by their amino acid analysis, revealed that the enzyme preferentially hydrolyzed the Arg-Arg or Arg-Lys bonds in dynorphins A 1-10, 1-9, and 1-8, beta-neoendorphin, adenorphin, and neurotensin.

Myocardial coagulation by intraoperative Nd:YAG laser ablation and its dependence on blood perfusion

To investigate whether the efficacy of intraoperative laser ablation therapy is affected by myocardial blood perfusion, we irradiated 11 canine hearts through the epicardium with a Nd:YAG laser (10, 20, and 30 J/mm2) using air as the medium. Compared coagulated myocardial depth, width, and volume obtained in the red beating heart was compared with those in the white nonbeating heart infused with 0 degrees C saline (cardioplegic model) via the coronary artery. Histologically, the macro- and microscopical findings were very similar. At each level of energy, the width and volume of red myocardium coagulated were significantly larger than those of white myocardium (P < 0.01). At 30 J/mm2, the depth of coagulation of red myocardium was significantly larger than that of white myocardium (P < 0.01). The coagulated volume of the white myocardium was about 60% of that of the red myocardium. Nd:YAG laser energy was absorbed by blood (red color = hemoglobin), and more energy was transferred in the higher temperature myocardium. During intraoperative Nd:YAG laser ablation, the presence of blood perfusion in cardiac tissue is thought to be an important factor affecting safe irradiation.

[Combined resection and replacement of the superior vena cava with an expanded polytetrafluoroethylene graft in surgery of pulmonary-mediastinal malignant tumor]

Combined resection and replacement of the superior vena cava with an expanded polytetrafluoroethylene graft was performed in 7 patients. Five patients had lung cancer, and 2 had malignant thymoma. During operation, total clamping of the superior vena cava was required in 2 patients, and partial clamping of the superior vena cava or clamping of the innominate vein in 5. The reconstruction procedures were as follows; the superior vena cava or bilateral innominate veins with a graft in 4 patients, bilateral innominate veins with 2 grafts in 1, and one of the innominate veins with a graft in 2. There was no operative death. Edema of face, neck and arms appeared in 6 patients postoperatively, but it disappeared in 3-10 days. Phlebogram which was obtained in 5 patients demonstrated patency of the grafts in 4 and well-developed collateral drainage in 1. Postoperative survival time was 1-27 months, and 3 patients are alive. No superior vena cava syndrome was recognized in long term observation of any patient.

A comparative study of patient satisfaction with health care in Japan and the United States

Patient satisfaction with medical care received at selected medical facilities in the United States (895 patients) and in Japan (856 patients) was compared using self-administered questionnaires. In each country, patients at a large government hospital and a smaller affiliated clinic were surveyed. Patients responded to questions concerning specific aspects of medical care, general satisfaction with the care received, waiting time to see the physician and time spent with the physician. Results suggest that patients at study sites in both countries were generally satisfied with the medical care they received. However, American patients were more likely to report satisfaction than their Japanese counterparts on each dimension of health care measured. The largest discrepancies were found in satisfaction with waiting time to see the doctor and time spent with the doctor. Stepwise discriminant analyses indicated that provider skill may be the most important predictor of overall satisfaction with medical care in both countries. These results are discussed in the framework of the underlying health care system.

Change in serum concentration of insulin-like growth factor II (IGF-II) in patients with thyroid disease

We investigated the serum concentration of IGF-II in patients with thyroid diseases (25 with untreated Graves' patients, 30 with hypothyroidism, 23 with thyroid adenoma) and in 72 healthy adults as normal controls, by a sensitive radioimmunoassay of serum IGF-II. Thyroid hormones are known to increase IGF-I production in the liver through the enhancement of GH secretion. In case of IGF-II, however, knowledge has been rather limited. The mean +/- SD concentration in healthy subjects was 556 +/- 94 micrograms/L with neither sex nor age dependence. In untreated Graves' patients, serum IGF-II levels (675 +/- 129 micrograms/L) were significantly (P < 0.01) higher than in normal controls, and significantly lower in patients with hypothyroidism (460 +/- 106 micrograms/L; P < 0.01). Thyroid hormones revealed positive correlation with the IGF-II concentration.

[[Attitudes on marriage among unmarried youths in contemporary Japan]]

"The purpose of this paper is to describe [attitudes on] marriage among unmarried youths in contemporary Japan, using the unmarried respondents' part of the Tenth Japanese National Fertility Survey carried out in July 1992." Aspects considered include the desirability of arranged marriage; desired age at marriage; desired characteristics of future spouse; women's attitudes on marriage and employment; and the desirability of residing with parents after marriage. (SUMMARY IN ENG)

Glucocorticoid inhibits cAMP production induced by vasoactive agents in aortic smooth muscle cells

It is well-known that atherosclerotic change and hypertension are common manifestations in patients with glucocorticoid excess. We previously reported that pituitary adenylate cyclase activating polypeptide (PACAP), prostaglandin E2 (PGE2) and carbacyclin, a stable analog of prostacyclin, have suppressive effects on vasopressin-induced DNA synthesis of rat aortic smooth muscle cells through cAMP production (Murase et al., J. Hypertens., 10 (1992) 1505; Oiso et al., Biochem. Cell. Biol., 71 (1993) 156). In the present study, we investigated the effect of glucocorticoid on cAMP production induced by PACAP, PGE2 and carbacyclin in aortic smooth muscle cells. The pretreatment with dexamethasone significantly inhibited cAMP accumulation induced by these vasoactive agents in a dose dependent manner in the range between 10 pM and 10 nM. These inhibitory effects of dexamethasone were dependent on the time of pretreatment up to 8 h. Dexamethasone inhibited cAMP accumulation induced by NaF, a GTP-binding protein activator, and forskolin which directly activates adenylate cyclase. Moreover, forskolin-induced adenylate cyclase activity was significantly reduced in membranes prepared from the cells treated with dexamethasone. These results strongly suggest that glucocorticoid inhibits cAMP production induced by vasoactive agents in primary cultured rat aortic smooth muscle cells and the inhibitory effect is exerted at the level of adenylate cyclase.

Primary and higher order structures of nematode (Ascaris suum) mitochondrial tRNAs lacking either the T or D stem

By fractionation using polyacrylamide gel electrophoresis and/or a preparative hybrid selection method employing solid-phase DNA probes, we prepared and characterized mitochondrial tRNAs from the body wall muscle of Ascaris suum, all of which are thought to lack either the T stem or the D stem from their gene sequences (Okimoto, R., and Wolstenholme, D. R. (1990) EMBO J. 10, 3405-3411). Some of the partially purified tRNAs were appreciably aminoacylated with an extract of A. suum mitochondria. The three species sequenced had CCA sequence at their 3'-ends, and tRNA(Met) had 5-formylcytidine at the anticodon first position, a new modified nucleoside found at the same position of bovine mitochondrial tRNA(Met) (Moriya, J., Yokogawa, T., Wakita, K., Ueda, T., Nishikawa, K., Crain, P. F., Hashizume, T., Pomerantz, S. C., McCloskey, J. A., Kawai, G., Hayashi, N., Yokoyama, S., and Watanabe, K. (1994) Biochemistry 33, 2234-2239). Enzymatic probing of these tRNAs supported the secondary structural model proposed by Okimoto and Wolstenholme in the reference cited above. Chemical probing of tRNA(Phe) demonstrated the existence of tertiary interactions between the (T arm-variable loop)-replacement loop and the D arm. The results suggest that these tertiary interactions enable the bizarre tRNAs of nematode mitochondria to maintain an L-shape-like structure in order to function in the nematode mitochondrial translation system.