Characteristics affecting cervical sagittal alignment in patients with chronic low back pain

BACKGROUND

Sagittal spino-pelvic malalignment in patients with chronic low back pain (CLBP) have been reported in the past, which may also affect cervical spine lesions. The purpose of this study is to investigate the cervical alignment in patients with CLBP.

METHOD

Of the patients who visited an orthopedic specialist due to low back pain lasting more than three months, 121 cases (average 71.5-years-old, 46 male and 75 female) with whole standing spinal screening radiographs were reviewed (CLBP group). Cervical parameters included cervical lordosis (CL), C2-C7 sagittal vertical axis (C2-7 SVA), and the T1 slope minus CL (T1S-CL). Cervical spine deformity was defined as C2-7 SVA >4 cm, CL <0°, or T1S-CL ≧20°. We compared the cervical alignment of these patients with 121 age and gender matched volunteers (control group).

RESULTS

The prevalence of cervical spine deformity was significantly higher in the CLBP group than in the control group (20.7% vs. 10.7%, P = 0.034). The mean CL was smaller in the CLBP group than in the control group (16.1° vs. 21.4°, P = 0.002). The mean C2-7 SVA was 17.6 mm vs. 18.7 mm in the CLBP group and in the control group, respectively (P = 0.817). The mean T1S-CL was larger in the CLBP group than in the control group (9.1° vs. 3.5°, P < 0.001). Multivariate analysis showed that people with CLBP were more likely to have cervical deformities than people without CLBP (odds ratio 2.16, 95% confidence interval 1.006 to 4.637).

CONCLUSIONS

This study results suggest that people with CLBP present with worse cervical sagittal alignment and higher prevalence of cervical spine deformities than age and gender matched volunteers with no CLBP. This means CLBP impacts cervical spine lesions negatively.

LEVEL OF EVIDENCE

Ⅳ.

CLINICAL CHARACTERISTICS OF NEUROPATHIC PAIN IN PATIENTS WITH CARPAL TUNNEL SYNDROME

The purpose of this study was to identify the clinical characteristics of neuropathic pain in patients with carpal tunnel syndrome. We retrospectively reviewed 143 hands in 127 patients with carpal tunnel syndrome. The neuropathic pain was determined by using the painDETECT as a self-administered psychometric questionnaire to distinguish neuropathic pain. There were no significant differences in the characteristics of the patients with and without neuropathic pain. However, there were significant differences in the pain scores between those with and without neuropathic pain (p < 0.01). Furthermore, there was a significant difference between the existence of night pain in these patients (p < 0.01). Based on the results of the current study, we conclude that it is important to be aware of, and consider the existence of neuropathic pain during the treatment of patients with carpal tunnel syndrome with night pain or a high score on the numerical rating scales of pain.

The relationship between neuropathic pain, and the function of the upper limbs based on clinical severity according to electrophysiological studies in patients with carpal tunnel syndrome

Carpal tunnel syndrome (CTS) is an entrapment neuropathy of the median nerve, and CTS can cause neuropathic pain. The aim of this study was to evaluate the relationship between neuropathic pain, function of the upper limb, and the electrophysiology in patients with CTS. The terminal latency of median nerve was measured in 34 patients diagnosed with CTS, and they were asked to fill out the Japanese Society for Surgery of the Hand version of the Disability of Arm, Shoulder, and Hand questionnaire (DASH-JSSH) as the patient's assessment of the function of upper limbs and pain DETECT as an assessment for neuropathic pain. There was no significant correlation between the terminal latency and the pain DETECT score, or the terminal latency and the DASH-JSSH score. However, there was a significant correlation between the pain DETECT and DASH-JSSH scores. Neuropathic pain affects the function of the upper extremities in patients with CTS.

Traumatic volar dislocation of the distal ulna with a fracture of the ulnar styloid

Isolated volar dislocation of the distal ulna without forearm fracture is very rare; however, this injury is incorrectly diagnosed in approximately 50% of cases. This injury can lead to a significant functional disability if left untreated. This report presents a case of isolated volar dislocation of the distal ulna with an ulnar styloid fracture. The dislocation was subsequently reduced, the styloid was surgically repaired, and the patient was satisfied at the last follow-up. The importance of a proper clinical examination and an accurate radiographic position of the wrist are stressed. Furthermore, clinical evaluation of the distal radioular joint after reduction is important in achieving good results. There are various strategies for the treatment of distal radioulnar joint after reduction, including conservative treatment or surgical treatment. We believe that surgical exploration could have been carried out at an earlier stage had such a lesion been suspected. Additional case reports of other instances of successful treatment are needed to educate orthopaedic surgeons and emergency medical technicians on the nature of this type of injury.

The G-protein on cholesterol-rich membrane microdomains mediates mucosal sensing of short- chain fatty acid and secretory response in rat colon

AIM

Short-chain fatty acids (SCFA) stimulate colonic contraction and secretion, which are mediated by an enteric reflex via a mucosal sensing and cholinergic mechanisms. The involvement of G-protein signal transduction was examined in the secretory response to luminal propionate sensing in rat distal colon.

METHODS

Mucosa-submucosa and mucosa preparations were used to measure short-circuit current (I(sc)) and acetylcholine (ACh) release respectively. Cholesterol-rich membrane microdomains, lipid rafts/caveolae, were fractionated using a sucrose gradient ultra-centrifugation after detergent-free extraction of the isolated colonic crypt.

RESULTS

Luminal addition of methyl-β-cyclodextrin (10 mm) and mastoparan (30 μm), lipid rafts/caveolae disruptors, significantly inhibited luminal propionate-induced (0.5 mm) increases in I(sc) , but did not affect increases in I(sc) induced by serosal ACh (0.05 mm) or electrical field stimulation (EFS). Luminal addition of YM-254890 (10 μm), a Gα(q/11) -selective inhibitor, markedly inhibited propionate-induced increase in I(sc) , but did not affect I(sc) responses to ACh and EFS. Both methyl-β-cyclodextrin and YM-254890 significantly inhibited luminal propionate-induced non-neuronal release of ACh from colonocytes. Real-time PCR demonstrated that in mRNA expression of SCFA receptors, GPR 43 was far higher than that of GPR41 in the colon. Western blotting analysis revealed that the cholesterol-rich membrane microdomains that fractionated from colonic crypt cells were associated with caveolin-1, flotillin-1 and Gα(q/11) , but not GPR43. Uncoupling of Gα(q/11) from flotillin-1 in lipid rafts occurred under desensitization of the I(sc) response to propionate.

CONCLUSIONS

These data demonstrate that the secretory response to luminal propionate in rat colon is mediated by G-protein on cholesterol-rich membrane microdomains, provably via Gα(q/11) .

Association between maximal oxygen uptake and the heart rate corrected-QT interval in postmenopausal overweight women

BACKGROUND

Increased aerobic capacity can reduce the incidence of cardiovascular disease and the mortality rate. On the other hand, a prolonged heart rate corrected-QT (QTc) interval is associated with an increased risk of arrhythmias, cardiac sudden death and coronary artery disease.

AIMS

The association of the aerobic capacity and coronary risk factors with QTc interval was investigated in postmenopausal overweight women.

SUBJECTS AND METHODS

The subjects included 84 postmenopausal overweight women [age: 58.7+/-6.4 years, body mass index (BMI): 27.9+/-3.3] with coronary risk factors. Electrocardiogram (ECG) was recorded with a standard resting 12-lead ECG after more than 5 minutes of rest. The QTc interval was automatically calculated according to Bazett's formula. A multistage graded submaximal exercise test was performed on an electric bicycle ergometer to determine the estimated maximal oxygen uptake (VO(2)max).

RESULTS

Single correlation analysis showed the QTc interval to be positively associated with hemoglobin A(1)c (HbA(1)c), fasting glucose, fasting insulin, BMI, waist circumference, serum potassium and the number of coronary risk factors, while negatively correlated with VO(2)max. Stepwise multiple regression analysis demonstrated the strong association of the QTc interval with HbA(1)c and VO(2)max (r(2)=0.244, p<0.0001). In both patients with and without metabolic syndrome (n=15, n=69, respectively), the QTc interval was independently associated with the HbA(1)c (r(2)=0.318, p<0.05, r(2)= 0.115, p<0.05, respectively).

CONCLUSIONS

These results suggest that decreased aerobic capacity and glucose intolerance may be independent risk factors for a prolonged QTc interval, while demonstrating no relationship with metabolic syndrome.

Effects of low intensity exercise therapy on early phase insulin secretion in overweight subjects with impaired glucose tolerance and type 2 diabetes mellitus

This study was designed to evaluate effects of exercise therapy on early phase insulin secretion in overweight subjects with impaired glucose tolerance (IGT) and type 2 diabetes mellitus (DM). The subjects consisted of overweight subjects with normal glucose tolerance (NGT, n=10), IGT (n=10) and DM (n=10) (age: 51.1+/-8.2, 56.3+/-8.8 and 58.5+/-6.2 years, respectively). All of these patients performed exercise therapy at lactate threshold intensity for 12 weeks. Before intervention, area under the glucose curve (AUC(PG)) was higher in DM, IGT and NGT groups, and area under the insulin curve (AUC(IRI)) and the early phase insulin secretion as calculated by insulinogenic index was higher in the NGT group than in either the IGT or DM groups (p<0.05). After exercise therapy, the insulin sensitivity, AUC(PG) and AUC(IRI) improved in three groups (p<0.05, respectively). The insulinogenic index increased in IGT and DM groups (p<0.05, respectively), but the changes in the insulinogenic index showed no significant differences between IGT and DM groups. These results suggest that the ss-cell function in subjects with IGT and DM could therefore improve after exercise therapy. Moreover, AUC(PG), AUC(IRI) and insulin sensitivity were also improved no relation to NGT, IGT and DM.

Association between silent ST segment depression in exercise electrocardiography and insulin resistance in obese subjects

OBJECTIVES

This study was designed to clarify the association between ST segment depression in exercise electrocardiography (ECG) and insulin resistance in obese subjects.

METHODS

A multistage graded submaximal exercise stress test on the bicycle ergometer was performed under CM5-lead ECG monitoring in 114 obese subjects (39 men and 75 women, mean age 50.9 +/- 12.2 years, mean body mass index 28.6 +/- 3.1 kg/m(2)).

RESULTS

In 27 patients showing ST segment depression at the final exercise intensities (abnormal ST), insulin resistance index by homeostasis model assessment (HOMA-IR) was higher and insulin sensitivity index was lower than in the remaining 87 patients with normal ST segment level (normal ST). The abnormal ST group showed significantly higher plasma glucose and serum insulin levels during the oral glucose tolerance test (OGTT) than the normal ST group. The abnormal ST group showed a significantly higher prevalence of hypertension, impaired glucose tolerance and metabolic syndrome than the normal ST group. Multiple logistic regression analysis showed that insulin resistance as evaluated by fasting insulin, sigma insulin during OGTT, HOMA-IR, insulin sensitivity index, the levels of uric acid, fasting glucose, systolic blood pressure and maximal oxygen uptake were independently associated with ST segment depression.

CONCLUSIONS

These results suggest that insulin resistance may involve pathological ST depression during exercise, as well as previously reported factors such as hyperglycemia, hyperuricemia, hypertension and lower aerobic capacity.

Extremely high dose neutron dosimetry using CR-39 and atomic force microscopy

Atomic force microscopy (AFM) has been applied to the analysis of CR-39 nuclear track detectors for high dose neutron dosimetry. As a feasible study to extract the neutron dose, we have employed a (239)Pu-Be neutron source with the traditional track density measurement of recoil proton etch pits from a high density polyethylene (CH(2)) radiator. After very short etching ( approximately 1 microm), etch pit densities were measured as a function of neutron fluence (neutron dose) up to 1.4 x 10(10) cm(-2) (6.6 Sv). Neutron sensitivity was also measured to be 6.6 x 10(-4). Maximum measurable neutron dose was estimated to be approximately 200 Sv by measuring the fraction of the total image area occupied by the etch pits.

Neuropeptide W is present in antral G cells of rat, mouse, and human stomach

Neuropeptide W (NPW) is a 30-amino-acid peptide initially isolated from the porcine hypothalamus as an endogenous ligand for the G protein-coupled receptors GPR7 and GPR8. An intracerebroventricular administration of NPW increased serum prolactin and corticosterone concentrations, decreased dark-phase feeding, raised energy expenditure, and lowered body weight. Peripherally, GPR7 receptors are abundantly expressed throughout the gastrointestinal tract; the presence of NPW in the gastrointestinal endocrine system, however, remains unstudied. Using monoclonal and polyclonal antibodies raised against rat NPW, we studied the localization of NPW in the rat, mouse, and human stomach by light and electron microscopy. NPW-immunoreactive cells were identified within the gastric antral glands in all three species. Double immunohistochemistry and electron-microscopic immunohistochemistry studies in rats demonstrated that NPW is present in antral gastrin (G) cells. NPW immunoreactivity localized to round, intermediate-to-high-density granules in G cells. NPW-immunoreactive cells accounted for 90% chromagranin A- and 85% gastrin-immunoreactive endocrine cells in the rat gastric antral glands. Using reversed-phase HPLC coupled with enzyme immunoassays specific for NPW, we detected NPW30 and its C-terminally truncated form, NPW23, in the gastric mucosa. Plasma NPW concentration of the gastric antrum was significantly higher than that of the systemic vein, suggesting that circulating NPW is derived from the stomach. Plasma NPW concentration of the gastric antrum decreased significantly after 15-h fast and increased after refeeding. This is the first report to clarify the presence of NPW peptide in the stomachs of rats, mice, and humans. In conclusion, NPW is produced in gastric antral G cells; our findings will provide clues to additional mechanisms of the regulation of gastric function by this novel brain/gut peptide.

Residual contrast medium in the cortex of the kidney around an infected renal cyst on CT: case report

We present a case of a patient with an infected renal cyst. Delayed computed tomography showed residual contrast medium in the cortex of the kidney around it. Delayed computed tomography might be useful to identify an infected renal cyst.

Successful treatment of relapsed blastic natural killer cell lymphoma with unrelated cord blood transplantation

The prognosis for blastic natural killer (NK) cell lymphoma is generally dismal. We report a patient who was successfully treated with unrelated cord blood transplantation (UCBT). A 15-year-old boy was diagnosed as having blastic NK cell lymphoma in the cervical lymph nodes. Autologous peripheral blood stem cell transplantation was performed on achieving a complete remission. However, the disease recurred in the bone marrow 6 months later. Chemotherapy induced a second remission and the patient received UCBT with a conditioning regimen consisting of total body irradiation, thiotepa and cyclophosphamide. Chronic GVHD of the lung occurred, but it was well controlled with steroids. At the time of writing, he remains in remission 18 months after UCBT with an excellent performance status. UCBT may be an option for patients with blastic NK cell lymphoma.

Association of alexithymic characteristics and posttraumatic stress responses following medical treatment for children with refractory hematological diseases

Recent research has examined posttraumatic stress disorder (PTSD) following medical treatment for children with refractory hematological diseases such as leukemia. However, much remains unknown. This study examined the association of alexithymic characteristics on the manifestation of posttraumatic stress responses in 33 children with refractory hematological diseases. Of 33 children, 27 (81.8%) exhibited posttraumatic stress responses following medical treatment for refractory hematological diseases. The frequency of posttraumatic stress responses was significantly higher than with children who experienced severe flood disaster. Also, the severity of posttraumatic stress responses was significantly stronger than for children who experienced severe flood disaster. Moreover, children with refractory hematological diseases were more likely to exhibit alexithymic characteristics. The alexithymic characteristics were significantly and positively correlated with avoidance and emotional numbing among posttraumatic stress responses. The results suggest the possibility that alexithymic characteristics may be predictive of the manifestation of avoidance and emotional numbing among posttraumatic stress responses following medical treatment for refractory hematological diseases.

Mycobacterium kansasii arthritis of the foot in a patient with systemic lupus erythematosus

Mycobacterium kansasii, an atypical Mycobacterium, may cause serious illness in humans. We describe a M. kansasii infection of the foot joint, which was diagnosed in a 46-year-old woman with systemic lupus erythematosus. The diagnosis was based on a positive culture from degenerative tissue and histological diagnosis of a synovium. We reviewed the literature regarding M. kansasii infection of the joint, bone, and periarticular structures focusing on the complication of rheumatic diseases.

[A case of adult neuroblastoma arising in the retroperitoneal space]

Neuroblastoma, common in children, rarely develops in adults. We recently treated a patient with adult neuroblastoma. A 34-year-old man complained of a swelling in right inguinal region. CT scan showed swelling of retroperitoneal and inguinal lymph nodes, and bone scintigram by 99mTc-HMDP showed an abnormal uptake in the swollen lymph nodes. Chemotherapy with CDDP (cisplatinum), VP-16 (etoposide), BLM (bleomycin), ADM (adriamycin) was not effective. Histopathological examination of a biopsy specimen revealed neuroblastoma. Another chemotherapy with CPM (cyclophosphamide), VCR (vincristine), ADM, DTIC (dacarbazine), CDDP, VP-16 was effective in decreasing the tumor size. Further high dose chemotherapy with CPM, ADM, CDDP, VP-16 combined with peripheral blood stem cell transplantation led to almost complete disappearance of the tumor and normalization of blood tumor markers (neuron specific enolase and immunosuppressive acidic protein). Retroperitoneal lymph node dissection demonstrated well-differentiated neuroblastoma in the excised tissue. Six months postoperatively, the tumor recurred in the pelvic cavity. Although chemotherapy and radiotherapy were given, he died of the disease 12 months postoperatively.

[Clinical study on mortality of rheumatoid arthritis compared with malignant rheumatoid arthritis]

OBJECTIVE

To determine how the mortality of patients with rheumatoid arthritis (RA) behave in comparison with that of patients with malignant rheumatoid arthritis (MRA).

METHODS

The mortality of RA patients selected at randam identified in 1991-2000 (n = 104) was compared with that of 18 MRA patients. Hazard ratios of death were calculated with a multivariate survival analysis. A clinical study of patients with both RA and MRA was performed in mortality.

RESULTS

Excess mortality was seen in MRA patients in Kaplan-Meier survival curves (p = 0.02 by log-rank test). MRA patients were treated more often with cytostatic and immunosuppressive drugs. Infection was the main cause of death in both RA and MRA patients. Vasculitis was not reported as the cause of death in MRA patients. Secondary amyloidosis played an important role in RA death rather than MRA.

CONCLUSION

There remained an excess mortality in MRA patients compared with RA, and infection was attributable to the key cause of death in both RA and MRA suggesting therapeutic side effects.

Human cytomegalovirus infection in foci of Langerhans cell histiocytosis

Langerhans cell histiocytosis (LCH) has been thought to be a disorder of immune regulation, and increasingly, evidence showing that the tissue damage in LCH involves lymphokines and pro-inflammatory cytokines is reported. We detected human cytomegalovirus (HCMV)-DNA in LCH cells in the foci of LCH lesions by immunohistochemistry, in situ hybridization and PCR. HCMV was detected in the nuclei and/or cytoplasm of LCH cells in 9 of 27 LCH cases by immunostaining. HCMV was probably an early antigen. In situ hybridization revealed signals for HCMV-DNA only in the nuclei of LCH cells in 10 of the 27 LCH cases. PCR analysis was performed in 20 of the LCH cases, and HCMV-DNA was detected in 7 of these. All 7 positive cases were also positive for HCMV by ISH and IHC. These findings suggested that early phase infection or reactivation of HCMV occurred in the LCH lesions. HCMV infection may be accompanied by impaired cytokine production. Our study also suggested a relationship between HCMV infection and expression of TNFalpha. In tissues affected by LCH, dermatopathic lymphadenopathy or malignant fibrous histiocytoma and in normal tissues no signals for Epstein-Barr virus-RNA were detected. These findings suggest that in some cases LCH is associated with HCMV infection.

Myeloperoxidase gene expression and regulation by myeloid cell growth factors in normal and leukemic cells

Myeloperoxidase (MPO) is present in azurophilic granules which appear in the promyelocyte stage of differentiation, and is the most common functional protein of myeloid cells. With progress in molecular biology, the expression and regulation of MPO have been clarified in normal myeloid and leukemic cells, not only by enzymatical activity but at the gene level MPO expression is affected by the differentiation of myeloid cells, and has been suggested to be regulated by myeloid cell growth factors, such as granulocyte colony-stimulating factor, granulocyte-macrophage colony-stimulating factor and interleukin-3. In the past decade the signal transduction from their receptors has been clarified. This review describes the expression and regulation of the MPO gene in myeloid cells including myeloid disorders, such as myeloid leukemia or myelodysplastic syndromes, The effects on MPO by myeloid growth factors and signal transduction from their receptors are also presented.

Alkaline phosphatase, defensin gene expression and effect of myeloid cell growth factors in normal and leukemic cells

In neutrophils, four different granules are defined, i.e. azurophil, specific, gelatinase and secretary vesicles. In these granules many neutrophil-specific constituents are identified. Some of these constituents have already been cloned and their gene expressions studied. In such constituents, alkaline phosphatase (ALP) and defensin are well known, although their functions are not yet fully clarified. ALP is present in secretary vesicles and has important roles in the diagnosis of some myeloid disorders. On the other hand, defensin is the most abundant functional peptide of neutrophils and is present in azurophillic granules. Which are subdivided into defensin-rich and defensin-poor granules. This review describes the expression of ALP and the defensin gene in normal and leukemic cells and the effect on these genes of myeloid growth factors, such as granulocyte colony-stimulating factor, granulocyte-macrophage colony-stimulating factor and interleukin 3.

Functional outcome of anterior transposition of the vascularized ulnar nerve for cubital tunnel syndrome

Anterior transposition of the ulnar nerve is a widely used treatment for cubital tunnel syndrome, but neurolysis performed at the time of surgery may impair the blood supply to the ulnar nerve. This study compared the results of intramuscular anterior transposition of the ulnar nerve with or without preserving the extrinsic vessels of the ulnar nerve in 35 patients. The postoperative nerve conduction velocity and the clinical results were better in the group in which the extrinsic vessels were presented.

Effects of glycerol on intracellular ice formation and dehydration of onion epidermis

Microscopic observations of freezing processes of onion epidermis have been carried out using a directional solidification stage. Effects of cryoprotectant on the intracellular ice formation and the dehydration were examined for several kinds of concentrations of glycerol in a wide range of cooling rate. With an increase of the glycerol concentration the ice formation due to the surface-catalyzed nucleation (SCN) at the plasma membrane was suppressed and the freezing temperature decreased. Especially, under a rapid cooling condition, a large supercooling should be achieved and we observed a different type of freezing in the lower temperature conditions. At the slower cooling rate, on the other hand, the use of glycerol can not prevent the cell shrinkage caused by the dehydration. It is also found that the intracellular ice formation and the dehydration under the ordinary cooling condition can be estimated based on the SCN theory by Toner et al. and Mazuar's dehydration model.

Minimized platelet interaction with poly(2-hydroxyethyl methacrylate-block-4-bis(trimethylsilyl)methylstyrene) hydrogel showing anomalously high free water content

Novel hydrophilic-hydrophobic block copolymers - poly(2-hydroxyethyl methacrylate-block-4-bis(trimethylsilyl)methylstyrene) (poly(HEMA-block-BSMS) or BH polymer) - were prepared as materials potentially useful for blood-contacting devices. Among the BH(X) series including poly(HEMA) itself, platelet adhesion and activation are minimum on the surface of BH(10), the block copolymer composed of 10 mol% of the hydrophobic segment. The unique physicochemical characteristics of BH(10) such as the high free water content and the increased mobility of PHEMA segments seem to play an important role in the prevention of platelet adhesion and activation. The water content of BH(10) was twice that of poly(HEMA) itself, even in the presence of 10 mol% of the hydrophobic moiety [poly(BSMS)]. Further, an anomalous increase in free water content was observed for the BH(10) sample measured by DSC. The glass transition temperature of BH(10) in the dry state was determined to be c. 10 degrees C, which was much lower than that observed for each of the homopolymers (c.f.: Tg [poly(HEMA)] = 70 degrees C; Tg [poly(BSMS)] = 160 degrees C), suggesting an increased mobility of tethered PHEMA segments in the BH(10) film.

[Crescentic glomerulonephritis in a patient with rheumatoid arthritis]

A 56-year-old female with rheumatoid arthritis was admitted because of bilateral hip pain. In a few months of her hospitalization, a relatively abrupt renal dysfunction was emerged besides complement breakdown, and renal biopsy revealed crescentic glomerulonephritis. Immunofluorescence study showed peripheral granular deposits of IgG, IgM, and C3 in the glomeruli. Cresents were predominantly composed of macrophages and glomerular epithelial cells. Amyloid nephropathy, renal vasuculitis, and association of other collagen vascular diseases were negligible for the causative factor. It was suggested that immune complexes were formed in the glomeruli, in which both humoral and cellular immune responses were to be induced, that brought cescents formation in the lesions. Crescentic glomerulonephritis in patients with rheumatoid arthritis is rare and a possible pathogenetic mechanisms involved in the development of renal dysfunction are discussed with the special reference to immune complex-induced inflammation.

Liposome encapsulated doxorubicin transfer to the pelvic lymph nodes by endoscopic administration into the bladder wall: a preliminary report

PURPOSE

Liposome encapsulated doxorubicin administered to the pelvic lymph nodes might be effective against pelvic node metastasis. We determined whether the drug can be delivered to the nodes via the bladder wall.

MATERIALS AND METHODS

Ten patients underwent endoscopic administration of 10 mg. liposomal doxorubicin into the bladder wall 3 days before cystectomy. The concentration of doxorubicin in the pelvic lymph nodes obtained at operation was measured.

RESULTS

No complication developed after drug administration. Almost all lymph nodes examined contained more than 100 ng./gm. doxorubicin (median 1,860).

CONCLUSIONS

Endoscopic administration of liposomal doxorubicin into the bladder wall may be an alternative method to deliver doxorubicin to the pelvic lymph nodes.