Assessing quality of life using the brief cancer-related worry inventory for gynecological surgery

BACKGROUND

The mental status of gynecologic patients has an important influence on their quality of life (QOL). Although high-quality QOL studies into breast cancer patients have been performed internationally, few QOL studies have examined patients with gynecological cancer.

AIM

To investigate the brief cancer-related worry inventory (BCWI) could evaluate the mental status of gynecological patients.

METHODS

Between July 2018 and December 2018, 19 consecutive gynecological cancer patients were prospectively recruited for this study. The BCWI is a 15-item self-reported questionnaire that assesses cancer-related worries on a numeric scale (0–100).

RESULTS

The high BCWI group was significantly younger than the low BCWI group. Regarding social status, the absence of a spouse and children was significantly more common in the high BCWI group than in the low BCWI group. The operation time was longer in the worsening BCWI group than in the stable BCWI group (305.3 ± 140.5 min vs 171.1 ± 97.2 min; P = 0.026).

CONCLUSION

Being young, having no family, and a long operation time were found to be risk factors for increased anxiety. Therefore, gynecological cancer patients should be assessed using the BCWI, and specific perioperative mental care should be considered for highly anxious patients.

Early and late elevation of plasma atrial and brain natriuretic peptides in patients after bone marrow transplantation

Clinical usefulness of bone marrow transplantation (BMT) remains limited by myocardial damage during the post-transplantation period. Measurements of plasma atrial and brain natriuretic peptides (ANP, BNP) during the acute post-transplantation period could serve to monitor cardiac complications since these peptides are known to increase in heart failure depending on its severity. We prospectively analyzed ANP and BNP levels from 14 days before to 100 days after BMT in 46 consecutive patients undergoing allogeneic (n=42) and autologous (n=4) transplantation. Cardiac performance was assessed by echocardiography and radionuclide ventriculography. BNP and ANP levels of the patients on admission (baseline: day-14) were 16.3+/-13.3 pg/ml and 14.4+/-8.8 pg/ml, respectively. There were two different types of changes in the BNP and ANP levels. The 21 patients in group I showed dual peaks of elevation on day 1 (BNP=164.4+/-136.0 pg/ml, P<0.01; ANP=44.5+/-35.4 pg/ml, NS) and day 14 (BNP=233.9+/-106.2 pg/ml, P<0.01; ANP=142.7+/-154.6 pg/ml, P<0.05), whereas the remaining 25 patients in group II had a single peak on day 1 (BNP=124.5+/-124.9 pg/ml, P<0.05; ANP=45.2+/-42.4 pg/ml, NS). The left ventricular ejection fraction on day 63 was unchanged in both groups of patients from the baselines. The time to peak filling rate, a parameter of diastolic function in the radionuclide ventriculography, was significantly prolonged in group I patients (by 30+/-53%), whereas unaffected in group II patients. These results suggest that plasma BNP monitoring for 2 weeks after BMT may be useful for early detection of patients at high risk for cardiac dysfunction in the post-transplantation period.

Distribution and properties of rat intestinal alkaline phosphatase isoenzymes

The ALP activities and properties of rat intestine cut into 20 segments were examined, and we were able to demonstrate that the ALP activity of upper intestine is high compared to that of lower intestine. This result coincided with those of other reports. However, we newly clarified that there is an ALP isoenzyme found in the lower intestine which can be inhibited by L-homoarginine. The molecular weight of the ALP isoenzyme was 136 kDa. In addition, it was clarified that there are several isoenzymes from upper to lower intestine. This study demonstrates that there exist isoenzymes, which are inhibited by L-HArg, in the intestine which are similar to the isoenzymes in the liver, bone and kidney.

[A case of Marchiafava-Bignami disease that responded to high-dose intravenous corticosteroid administration]

We report a 63-year-old male who presented acute confusional state with prominent rigidity of all extremities. The patient had a long history of alcoholism and was in poor physical condition and malnourished. The diagnosis of Marchiafava-Bignami disease was indicated by T2-weighted MRI demonstrating high signal intensity in the corpus callosum. Because Wernicke's encephalopathy was suspected as a complication, thiamine therapy was applied, but there was no clinical improvement. Immediately after high-dose intravenous corticosteroid administration was started, his symptoms rapidly resolved except for mild cognitive impairment. It is supposed that edematous change in the early stages of Marchiafava-Bignami disease causes impairment of the blood-brain barrier. Steroid therapy may prevent such a process by means of its the anti-edema effect and by normalizing blood-brain barrier. The present case suggests that corticosteroid therapy has beneficial effects for Marchiafava-Bignami disease.

Correlation of diversity of leg morphology in Gryllus bimaculatus (cricket) with divergence in dpp expression pattern during leg development

Insects can be grouped into mainly two categories, holometabolous and hemimetabolous, according to the extent of their morphological change during metamorphosis. The three thoracic legs, for example, are known to develop through two overtly different pathways: holometabolous insects make legs through their imaginal discs, while hemimetabolous legs develop from their leg buds. Thus, how the molecular mechanisms of leg development differ from each other is an intriguing question. In the holometabolous long-germ insect, these mechanisms have been extensively studied using Drosophila melanogaster. However, little is known about the mechanism in the hemimetabolous insect. Thus, we studied leg development of the hemimetabolous short-germ insect, Gryllus bimaculatus (cricket), focusing on expression patterns of the three key signaling molecules, hedgehog (hh), wingless (wg) and decapentaplegic (dpp), which are essential during leg development in Drosophila. In Gryllus embryos, expression of hh is restricted in the posterior half of each leg bud, while dpp and wg are expressed in the dorsal and ventral sides of its anteroposterior (A/P) boundary, respectively. Their expression patterns are essentially comparable with those of the three genes in Drosophila leg imaginal discs, suggesting the existence of the common mechanism for leg pattern formation. However, we found that expression pattern of dpp was significantly divergent among Gryllus, Schistocerca (grasshopper) and Drosophila embryos, while expression patterns of hh and wg are conserved. Furthermore, the divergence was found between the pro/mesothoracic and metathoracic Gryllus leg buds. These observations imply that the divergence in the dpp expression pattern may correlate with diversity of leg morphology.

[Disturbance of deep sensation in medial medullary syndrome. Topographical localization of medial lemniscus in the medulla oblongata]

Medial medullary infarction is characterized by ipsilateral hypoglossal nerve palsy with contralateral hemiparesis and disturbance of deep and discriminative sensory perception. We examined the extent and distribution of disturbances in deep sensation and compared the findings with the lesion location in the medial lemniscus detected by MRI in 3 patients with medial medullary infarction. We classified the lesion location into 2 groups; type I and type II. Type I was ventral to the middle medial lesion of the medial lemniscus, and type II was ventral to the dorsal medial lesion. In our series, type I (Case 1) impairment of the three kinds of deep sensations was more severe in the lower extremities than in the up-per extremities. In type II (Cases 2, 3) the severity or impairment in the upper extremities was moderate or severe and nearly equal to that in the lower extremities. There was no difference in the severity of impairment for the four kinds of discriminative sensations. In the literature, type I (8 patients) impairment of position sense in deep sensation was found in 1 of 7 patients in the upper extremities and 5 of 7 patients in the lower extremities. Impairment of vibration sense was found in 1 of 7 patients in the upper extremities and in all patients in the lower extremities. In type II (14 patients) severe impairment of position and vibration sense in deep sensation was found in 3 patients in the upper extremities equal to that in the lower extremities. There was no tendency in the severity of impairment of four kinds of discriminative sensations. Including our 3 cases and 22 in the literature, impairment of deep sensation was more severe in the lower extremities than in the upper extremities in type I (9 patients) and the extent was none (7), mild or moderate (2) in the upper extremities, mild (2), moderate (1), severe (2), obscure (4) in the lower extremities, while in type II (16 patients) the severity in the upper extremities was nearly equal to that in the lower extremities and the extent was none (1), mild or moderate (1), severe (5), obscure (9) in the upper extremities, none (2), mild or moderate (1), severe (6), obscure (7) in the lower extremities. It is concluded that hemiparesis appeared with lesions located in the pyramidal tract of the medulla, hemiparesis and disturbance of deep sensation in the upper and lower extremities, predominantly in the lower extremities with the lesion of the pyramidal tract to the middle of medial lemniscus in the medulla, hemiparesis and disturbance of the upper and lower extremities deep sensation with lesions of the pyramidal tract to the whole of the medial lemniscus in the medulla. Evaluating deep sensation of the upper and lower extremities is useful for speculation of the lesion location in the medial lemniscus in medial medullary infarction.

Identification of rat serum alkaline phosphatase isoenzyme by means of wheat germ agglutinin

Wheat germ agglutinin (WGA) precipitates bone type serum alkaline phosphatase (sALP) isoenzyme specifically. The precipitates are composed of the macromolecules of WGA and "bone type sALP" (WGA-ALP complex). In order to use bone type sALP as a marker in polyacrylamide gel electrophoresis (PAGE), a method to separate "bone type sALP" from the "WGA-ALP complex" was established by using N-acetyl-D-glucosamine (GlcNAc)-Sepharose 6E column chromatography. It was concluded that this method is useful for clinical examination in the rat.

Changes of serum alkaline phosphatase isoenzymes in fasted rats

Changes of serum alkaline phosphatase (sALP) isoenzymes under fasting conditions were examined using polyacrylamide gel electrophoresis (PAGE), amino-acids (L-phenylalanine (L-Phe), L-homoarginine (L-HArg)) inhibition and wheat germ agglutinin (WGA) treatment. The sALP of non-fasted rats was separated into three bands (S1, S2, S3) by PAGE. The molecular weight (M.W.) of S1 corresponded to that of an isoenzyme found in the ileum. By the addition of L-Phe, the staining intensity of S1 was weakened, S2 and S3 remained unchanged and the total activity of the isoenzymes extracted from intestine decreased. On the other hand, the activity of isoenzymes extracted from kidney and bone decreased by the addition of L-HArg. Therefore, S1 was judged to be derived from intestine. The activities of total sALP and S1 decreased from 16 h of fasting. Total sALP activity and sALP activity of the supernatant prepared by WGA treatment decreased, whereas the ALP activity of the precipitate (difference between total sALP activity and supernatant sALP activity) did not change. The activity band of the precipitate corresponded to that of S3 by PAGE. Therefore, S3 was judged to be derived from bone. In conclusion, under fasting conditions, the activity of S1 decreased while the activities of S2 and S3 remained unchanged.

The relation between crossed cerebellar blood flow and severities of hemiplegia: a technetium-(99m) hexamethylpropylene amine oxine SPECT study using Patlak plot method

Crossed cerebellar diaschisis (CCD), decrease in crossed cerebellar blood flow (CCBF) (ml/100g/min), is often observed in the cerebral blood flow imaging of hemiplegic patients. We studied the relations between severities of hemiplegia and degrees of CCD. Severities of hemiplegia were evaluated by Brunnstrom stages (Br. stage) of lower limbs. Degree of CCD was evaluated as CCBF and asymmetry index (ASI) (%) of CCBF, which were calculated from technetium-(99m) hexamethylpropylene amine oxine ((99m)Tc HMPAO) SPECT study using Patlak plot method (Matsuda et al. 1992, 1993). We have studied twenty consecutive patients. The CCBF was significantly different between Br. stage II and IV (p = 0.0357), III and IV (p < 0.001) and III and V (p < 0.001). ASI was significantly different between II and IV (p = 0.0357), III and IV (p < 0.001) and III and VI (p = 0.0238). Both of CCBF and ASI of the group of II and III were significantly lower than those of the group of IV, V and VI (p = 0.0033 for CCBF and p = 0.0087 for ASI). We conclude that this study indicate a close correlation between the sevreties of hemplegia and the degrees of CCD.

[Periodic decerebrate spasm with ocular dipping, Cheyne-Stokes respiration and hypersympathetic activity]

Decerebrate spasm is a generalized muscular spasm produced by some stimuli on decerebrate posture. Such spasm are called "tonic fit" or "decerebrate extensor spasm". We reported a 50-year-old man with periodic decerebrate spasm after cerebral hemorrhage. On admission, the patient was comatose. The pupils were round but anisocoric and did not react to light. Corneal reflexes were absent. The face, arms, and legs did not move voluntarily. Two weeks after admission, he was found in decerebrate rigidity. Periodic decerebrate spasms were also observed and were accompanied by ocular dipping. Cheyne-Stokes respiration, and hypersympathetic activity (transiently dilated pupils, hypertension, tachycardia). These symptoms persisted for two months and were induced by painful or sonic stimuli and suppressed by sleep, sedative or antiedematous drugs. The cycle was 0.6 approximately 0.7 per minute in accord with that of Cheyne-Stokes respiration. Magnetic resonance imaging revealed an area of low signal intensity in the midbrain to the bottom of the pons caused by the tentorial herniation on T1-weighted images. From the the clinical features and results of MRI studies, we considered that dysfunction of the midbrain to the pons in addition to diffuse cerebral dysfunction played some role in the manifestation of periodic decerebrate spasm with ocular dipping.

Effects of repeated doses of compound E for 4 and 9 weeks on the male reproductive organs

Results of two toxicity studies of Compound E, which is an anticancer drug, on male reproductive organs and fertility by oral repeated dosing at dose levels of 12.5, 25 and 50 mg/kg/day for 4 and 9 weeks in rats were compared. After repeated dosing, the male fertility was studied by mating with untreated female animals. At the dose of 50 mg/kg/day in the 4-week study, Compound E significantly decreased testes weight and number of epididymal sperm, caused histopathological changes in the testis and epididymis characterized by decreased germ cells, but did not affect fertility. The dose of 25 mg/kg/day in the 9-week study caused reduction in epididymal weight and number of epididymal sperm and histopathological changes in the testis. The dose of 50 mg/kg/day in the 9-week study was lethal and caused more prominent toxic effects in the reproductive organs and loss of fertility. The present studies suggest that the order of sensitivity of parameters on male reproductive organs is as follows; histopathological examination = organ weight > number of sperm in epididymis > pregnancy index> copulation index. Further, 4-weeks repeated dosing is of sufficient duration to predict adverse effects of test compounds.

Effects of a daily feeding-restriction on the reproductive and development toxicity parameters in female rats

On the assumption of that the oral administration of an acid-unstable test compound into the empty stomach could enhance the systemic exposure to the test compound, the non-pregnant and pregnant rats had free access to the diet only for five hours per day. Female rats under the restricted feeding for a period of 21 days took diet at two thirds of the daily food-intake by the control animals, and lost their weight more than 10%. The vaginal smear test in these animals revealed a prolonged estrous cycle and diestrous period over four days. On the other hand, the restricted feeding from Day 0 to Day 17 of gestation suppressed the weight gain of pregnant animals but did not cause any significant influence upon the litter data, incidence of external anomalies or fetal skeletal development. The restricted feeding from Day 0 of gestation to Day 7 of lactation seriously disturbed the nursing behavior and the growth of offspring. These results suggested that the dosing method under the above-mentioned restricted feeding might be applicable to the teratology study but could not be applied to the fertility study nor to the peri- and post-natal study.

[Acute disseminated encephalomyelitis presented with apnea in the acute stage]

A 33-year-old man was admitted to our hospital because of tetraplegia and dyspnea in November 4, 1991. He had been healthy until October 22, 1991, when he developed difficulty in urination, ascending paralysis, respiratory paralysis and oscillopsia. On admission, neurological examination showed transverse myelopathy below the level of fourth cervical cord segment, opsoclonus and respiratory paralysis, which developed apnea. Cell numbers and protein concentration in CSF were elevated 37/mm3 and 380 mg/dl respectively. MRI disclosed increased signal intensity area at the upper cervical cord and brainstem. From these findings, the patient was diagnosed as acute disseminated encephalomyelitis (ADEM). Cases of ADEM associated with respiratory paralysis in the acute stage are rare. An extended lesion of respiratory upper motor neuron descending from the medulla oblongata to the upper cervical cord may be involved, and resulted in respiratory paralysis in this case.

[Bilateral abducens nerve palsy followed by pseudoathetosis due to pontine hemorrhage--clinical and neuroradiological study]

Reported here are two cases with pontine hemorrhage presented with bilateral abducens nerve palsy and followed by pseudoathetosis, ataxia, and hemiparesis on the contralateral side of the lesion. The first case, a 57-year-old man, who suffered from bilateral abducens nerve palsy, deafness and hypoesthesia, ataxia, and hemiparesis of the right side of the body. MRI showed the confined lesion in the left side of tegmentum at the level of middle pons. When the abducens nerve palsy began to improve, pseudoathetosis of the right fingers appeared. About six months later, symptoms almost recovered, except for ataxia. The second case, a 48-year-old man who suffered from bilateral abducens nerve palsy, deafness of the left ear, and ataxia, hypoesthesia, and hemiparesis of the left side of the body was admitted. MRI disclosed a small lesion on the right side of the tegmentum at the level of middle pons. When the bilateral abducens nerve palsy was beginning to improve, pseudoathetosis of the left hand appeared. Three months later, pseudoathetosis of the left hand disappeared. Both patients presented here had a similar lesion in the tegmentum at the level of middle pons on the side contralateral to the side in which the pseudoathetosis was seen. Considering the clinical symptoms and radiological findings of these cases, it appears that a lesion which causes such rare neurological symptoms may involve the medial lemniscus, spinothalamic tract, lateral lemniscus, spinocerebellar fiber, and central tegmental tract at the tegmentum of the middle pons on the side contralateral to the cerebellar signs and pseudoathetosis.

[Clinical evaluation on serum osteocalcin in advanced prostate cancer patients]

The clinical significance of osteocalcin as a marker for advanced prostate cancer was examined. Osteocalcin is produced by osteoblasts and is also detected in the blood. Its change is a good index of osteometabolic diseases and especially of the osteoblastic activity. In the present study, we examined the serum osteocalcin concentration of those patients with urogenital tumor, especially prostate cancer, who had been confirmed for multiple bone-metastasis by clinical examination. These patients comprised an untreated group (15 cases) of patients with prostate cancer presenting confirmed bone-metastasis, and a group of patients without bone-metastasis. The respective serum osteocalcin concentrations of these two groups were compared with 51 cases of prostate hypertrophy used as the control group. The findings revealed that the serum osteocalcin concentration demonstrated high values in the first group with a tendency toward lowering during treatment. Neither the latter group nor the control group showed high values. On the other hand, false-positive cases (8%), and false-negative cases (20%) were found. In the case of bone-metastasis, these results suggest that measurement of serum osteocalcin concentration is useful for clinical periodical observation about the activity of the bone metastatic focus.

[A case of advanced prostatic cancer presenting as inguinal mass]

A 71-year-old man visited our hospital complaining of a nodule in the left inguinal region. Pathological and immunohistochemical examination of the prostate and the mass and clinical examination revealed a case of prostatic cancer with lymph node metastasis, stage D. Chemoendocrine therapy (diethylstilbestrol diphosphate, cisplatin, adriamycin and carboquone) was performed and the patient responded well. This case indicated the presence of an unusual prostatic cancer in which large non-regional superficial lymph node metastasis occurred.

Energy utilisation in germ-free and conventional chicks fed diets containing sorbose

1. In experiment 1, growing conventional (CV) chicks were fed on diets containing graded amounts (0, 100, 200 and 300 g/kg diet) of sorbose from 4 to 14 d. Protein, fat and energy deposition were determined after carcase analysis. The values for growth, food efficiency, metabolisable energy (ME) and fat and energy depositions declined as the dietary sorbose content increased. 2. In experiment 2, the performances of germ-free (GF) and CV chicks fed on diets with (100 g sorbose/kg diet) or without sorbose were investigated. On both diets, body weight gain, food consumption and protein accumulation in GF chicks were significantly higher than those in CV birds. No significant differences were observed between the dietary treatment except for ME values, which were significantly lower for the sorbose diet. 3. It is suggested that dietary sorbose decreased energy utilisation, and that the microbial contribution to the utilisation of dietary sorbose was negligible in the chicken.

Effect of short chain fatty acids on the performance and intestinal weight in germ-free and conventional chicks

1. In experiment 1, the performance and tissue weights of germ-free (GF) and conventional (CV) chicks fed on diets containing 25.4 g acetic acid/kg diet (AD) or 25.4 g kaolin/kg diet (KD) were investigated. Body weight gain in GF chicks was significantly higher on the AD, but significantly lower on the KD compared with their CV counterparts. The values for food efficiency, protein retention and energy retention followed a similar pattern to that of the body weight gain. 2. The weights of all sections of the intestine except the colon were significantly greater in CV chicks. In CV but not in GF birds the jejunum and ileum were heavier from birds fed on the AD than from those on the KD diet. 3. In experiment 2, the influence of butyric acid administration on the weight of some organs in chicks was investigated. The weight of duodenum, jejunum and ileum was significantly increased by intraperitoneal administration of butyric acid (2 ml of 100 mM solution/d) for 4 d, but no significant effect was observed by oral administration. 4. It might be suggested that short chain fatty acids such as acetic and butyric acids formed by bacterial action in the crop and subsequently absorbed are at least partly responsible for the heavier gut weight in CV birds.

Sleep pattern in children with intractable epilepsy and mental retardation

Four cases with intractable epilepsy and mental retardation (Epi + MR), four cases of mental retardation (MR), one case of mental retardation without epileptic seizures for the last several years (MR + (Epi] and two normal children were studied on their sleep pattern. Besides these, two cases of epilepsy (Epi) were examined. Awake time increased in the Epi + MR group. Slow wave sleep decreased markedly in the Epi + MR group. REM sleep decreased in the MR + (Epi) and Epi + MR groups. REM density was lowered in the following order: normal----Epi----MR----Epi + MR groups. The difference of sleep pattern among the normal, Epi and MR groups was not exhibited clearly, but severe sleep disturbances were shown in the Epi + MR group, implicating the severe brain dysfunction in the cortex and the brain stem.

Rotation detection by optical heterodyne fiber gyro with frequency output

A fiber gyro with optical heterodyne detection is proposed. The experimental setup has been constructed and tested. Both the frequency difference in the fiber and the path-length difference between counterpropagating waves are eliminated to reduce output drift. An electronic circuit for phase-nulling detection has been constructed, which gives an electronic frequency output in proportion to the rotation rate. Direct frequency modulation of a single-mode laser diode has been adopted to reduce the noise that is due to the backward Rayleigh scattering. A short time resolution of the rotation rate of about 5 deg/h for an integration time of 1 sec. (0.0014 deg/sec) has been achieved with good linearity, for an integration time of 1 sec.

Fiber-optic laser gyro with easily introduced phase-difference bias

An optical system for easy introduction of phase-difference bias to optimize the sensitivity of the fiber-optic laser gyro is proposed. The theory of using a laser diode has been considered, and the rotation detection experiment has been performed. The experimental setup consists of a 300-m long single-mode optical fiber, individual optical components, and a laser diode stabilized by a thermal controller and an optical isolator. Short-time resolution of the rotation rate better than 0.87 mrad/sec has been achieved with good linearity.