[Gastric Gastrointestinal Stromal Tumor Appearing Nine Years after Resection of a Duodenal Gastrointestinal Stromal Tumor-A Case Report]

Multiple sporadic gastrointestinal stromal tumor(GIST)are rare, except for those restricted to von Recklinghausen disease or hereditary conditions.We reported a case of a gastric GIST resected 9 years after the resection of a duodenal GIST.The patient was a 58-year-old male who had been followed-up with computed tomography scans after pancreatoduodenectomy for a duodenal GIST when he was 49-years-old.The patient was admitted to our hospital for anemia examination.A CT scan detected a tumor in the stomach, with a diameter of over 10 cm, and necrosis.Esophagogastroduodenoscopy revealed the presence of a delle on the gastric SMT.Due to suspected invasion of the spleen and left diaphragm by the tumor, we performed subtotal gastrectomy with splenectomy and left diaphragm segmental resection.In the pathological diagnosis, the tumor was diagnosed as a gastric GIST, because the cell type of the tumor was spindle and tested positive for c-kit.Based on the tumor size and mitotic count, the patient was diagnosed with high-risk GIST by the modified-Fletcher classification, and imatinib 400mg/day was administered.There have been no signs of recurrence for 2 years since the operation.

Quantitative evaluation and visualization of lumbar foraminal nerve root entrapment by using diffusion tensor imaging: preliminary results

BACKGROUND AND PURPOSE

DTI can provide valuable structural information that may become an innovative tool in evaluating lumbar foraminal nerve root entrapment. The purpose of this study was to visualize the lumbar nerve roots and to measure their FA in healthy volunteers and patients with lumbar foraminal stenosis by using DTI and tractography with 3T MR imaging.

MATERIALS AND METHODS

Eight patients with lumbar foraminal stenosis and 8 healthy volunteers underwent 3T MR imaging. In all subjects, DTI was performed with echo-planar imaging at a b-value of 800 s/mm(2) and the lumbar nerve roots were visualized with tractography. Mean FA values in the lumbar nerve roots were quantified on DTI images.

RESULTS

In all subjects, the lumbar nerve roots were clearly visualized with tractography. In all patients, tractography also showed abnormalities such as tract disruption, nerve narrowing, and indentation in their course through the foramen. Mean FA values were significantly lower in entrapped roots than in intact roots.

CONCLUSIONS

We demonstrated that DTI and tractography of human lumbar nerves can visualize and quantitatively evaluate lumbar nerve entrapment with foraminal stenosis. We believe that DWI is a potential tool for the diagnosis of lumbar nerve entrapment.

[Thoracic aortic aneurysm due to giant cell arteritis without any specific symptom]

A 76-year-old female was admitted to our hospital for investigation and treatment of aortic regurgitation. She was found to have an ascending aortic aneurysm extending to the proximal arch. She had not suffered from any symptoms except chest discomfort. Total arch replacement and aortic valvoplasty were performed under cardiopulmonary bypass. Pathological examination of the aneurismal wall revealed giant cell arteritis. Aortic aneurysm due to giant cell aortitis without such symptom as temporal pain or polymyalgia was considered to be very rare.

[Gigantic coronary aneurysm arisen from coronary fistula between the left circumflex artery and the left ventricle]

A 71-year-old male was referred to our hospital due to abnormality detected by a chest roentgenogram. He had no symptoms except for slight chest oppression. He was found to have a giant coronary aneurysm. It was originated from a coronary artery (left circum flex branch) left ventricular fistula. The orifice of this fistula to the left ventricle was also dilated and formed diverticulum. Ligation of the feeding coronary branch, closure of the aneurysmal fistula in the left ventricular wall and aneurysmectomy were performed under cardiopulmonary bypass. Postoperative course was uneventful. A giant aneurysm originated from a coronary-left ventricular fistula was considered to be very rare.

[A case of sepsis by Neisseria meningitidis beginning with pneumonia during a trip abroad]

A 62-year-male presented a high fever and a dry cough during a trip to Australia. He was admitted to a hospital as soon as be returned to Japan. The next day after returning to Japan, he was transferred to our hospital with septic shock and loss of consciousness. Neisseria meningitidis was cultured from his blood. N. meningitidis is rare in Japan. However its seems common, in some foreign countries. With these findings, it can be postulated that N. meningitidis might be one of the etiological agents of the imported infectious disease.

Direct refolding of recombinant human growth differentiation factor 5 for large-scale production process

An efficient downstream process for the production of recombinant human growth differentiation factor 5 (rhGDF5) has been developed for industrial application utilizing a novel "direct refolding" method. In this method, the starting material is an inclusion body produced in Escherichia coli, and the critical step is the direct refolding step that follows directly after solubilization of the inclusion body. rhGDF5 can be refolded at a markedly high concentration of 2.4 mg.ml(-1), which is 24 times that hitherto achieved by the proteins of the TGF-beta superfamily. The refolding yield is 63%, and after purification by diafiltration, isoelectric precipitation and reverse-phase chromatography, the final purification yield is 20% with purity higher than 99%. The yield is more than twice that of a conventionally established process having three chromatography steps and the purity is equivalent. The first pilot-scale trial shows a refolding yield of 51% and a final yield of 11%. The final yield is 1.4 times that of the conventional process, and further optimization at pilot-scale is expected to bring this figure up to or above that of laboratory-scale. As a result, the calculated production cost of rhGDF5 has been reduced dramatically. This type of efficient and simple process is beneficial particularly in the large-scale production of recombinant proteins in which high yield and quality are required.

[A case of fluorouracil-induced pneumonitis]

A 73-year-old man with colon cancer had been treated elsewhere for pneumonia on June 12, 1994. He was admitted to our hospital on June 21 with progressive dyspnea and bilateral diffuse infiltrates on chest X-ray. On admission, plain chest radiographs and chest CT scans revealed bilateral interstitial shadows predominantly in the outer zone, of the lower lobes. After an operation for rectal cancer, he had begun taking orally 300 mg of fluorouracil daily for 64 days. A drug lymphocyte stimulation test (DLST) was positive for fluorouracil. Fluorouracil-induced pneumonitis was subsequently diagnosed. To the best of our knowledge, there have been no previous case reports of fluorouracil-induced pneumonitis, and it seems likely that this pneumonitis resulted from both toxic and allergic reactions to the drug.

[Random biopsy and recurrence risk in patients with bladder cancer]

BACKGROUND

We studied the relationship between the recurrence rate of primary superficial bladder cancer and random biopsy.

METHODS

We performed transurethral resection of primary superficial bladder cancer in 144 patients, and in 55 of those cases a random biopsy was also performed. The non-recurrence rate was examined in many recurrence facters.

RESULTS

The non-recurrence rate in the group with random biopsy was not significantly different from that observed in the group (100 patients) without random biopsy (chi 2 test, Generalized Wilcoxon test and multivariate analysis). Because the intravesical instillation therapy is an important inhibition factor in the recurrence rate of the primary superficial bladder cancer, we further analysed the recurrence rate in two non treated groups with or without random biopsy (13 and 35 patients respectively). No significant difference in the rate of recurrence between the two groups was observed. However, we noted recurrence of bladder cancer at biopsy positions in 8/13 patients.

CONCLUSION

It appears that random biopsy may have an effect on the recurrence or the implantation of tumor cells. Further studies are needed to clarify whether random biopsy is a risk factor in the recurrence rate of primary superficial bladder cancer.

Aetiology of maxillofacial fracture

The aetiological factors associated with maxillofacial fractures, and the trends in these factors over a 13 year period are reported. The First Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tokyo Medical and Dental University, managed 695 patients with maxillofacial fractures between 1977 and 1989. The male to female ratio was 3.2:1 and the majority of patients were aged between 10 and 30 years old. Road traffic accidents and accidental falls were the main causes of fractures throughout the 13 year study period. Mandibular fractures occurred in 477 patients (68.6%). A high percentage of patients were treated by closed reduction and maxillo-mandibular fixation, or occlusal splinting.

Sequence in DNA synthetic phase ratio of spontaneous hypertensive rat (SHR) myocardium--study on development of cardiomegaly

We studied the relative synthetic phase (S-phase) ratio of cardiac myocytes of spontaneously hypertensive rats (SHR) utilizing monoclonal antibody to 5-bromo 2'-deoxyuridine (BrdU), a halogen derivative of thymidine. BrdU was administered intraperitoneally to SHR and Wistar Kyoto rats at 66.7 mg/kg/day for 3 consecutive days. The rats were sacrificed 1 week after the first injection of BrdU. Using anti-BrdU antibody, myocardial tissue was stained by the avidin biotinylated peroxidase complex method. We assessed the ability of the nuclei to synthesize DNA. The percentage of BrdU-labeled myocytes was higher in SHR than in control rats at 9 weeks. The hyperplastic phase of heart growth in rats was presumed to occur about 3 weeks after birth. From these results, the ability of the myocardial cell to synthesize DNA is probably enhanced under the load of high blood pressure in the early hypertrophic phase following hyperplasia.

Multiple intrahepatic portosystemic venous shunts: treatment by portal vein embolization

A rare case of symptomatic, multiple, intrahepatic, portosystemic venous shunts which was treated by portal vein embolization after surgical cannulation is reported. The patient, having suffered from hepatic encephalopathy, improved dramatically after embolization. This method might be the only choice of therapy for intrahepatic portosystemic shunts of this kind.

[Diagnosis and surgical treatment of accessory mitral valve with associated congenital heart disease]

Accessory mitral valve (AcMV) is a rare cardiac anomaly that may possibly cause left ventricular outflow tract (LVOT) obstruction. Five patients who underwent surgical resection of AcMV were reported. All these patients had associated cardiac anomalies, which include transposition of great arteries (TGA) in two cases, ventricular septal defect (VSD) in one, double outlet right ventricle (DORV) in one and membranous septal aneurysm (MSA) in one. Age at operation ranged from 23 days to 22 months. In these cases preoperative pressure gradient across the LVOT ranged from 10 to 35 mmHg. Resection of AcMV was performed together with radical operation for associated anomalies in all the patients. Approach for resection of AcMV consisted of trans-ventricular septum method in 3 patients of VSD, DORV or MSA and trans-pulmonary artery method in 2 cases of TGA. There was no operative death. The postoperative pressure gradient across the LVOT ranged from 0 to 13 mmHg. Two dimensional echocardiography was essential for the accurate preoperative diagnosis of AcMV in 4 out of the 5 patients. The trans-ventricular septum method, when the large VSD was present, for resection of AcMV was found to be quite useful especially for neonates in order to obtain an excellent operative field, as compared with the conventional method.

[Bacteriological, pharmacokinetic and clinical studies of cefpirome in the field of pediatrics]

Bacteriological, pharmacokinetic and clinical studies on cefpirome (CPR, HR 810), a new cephem antibiotic, were carried out in the field of pediatrics. The results obtained are summarized below. 1. Antibacterial activities of CPR against clinically isolated strains of Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyogenes, Streptococcus agalactiae, Escherichia coli, Klebsiella pneumoniae, Haemophilus influenzae and Haemophilus parainfluenzae were superior to those of ceftazidime. 2. Plasma concentrations and urinary excretion rates after intravenous bolus injection of CPR at doses of 10, 20 and 40 mg/kg for 5 minutes in 2 cases each were determined. Mean peak plasma concentrations of CPR at these dose levels were 33.9, 62.9 and 96.0 micrograms/ml at 15 minutes with plasma half-lives of 1.58, 1.69, and 2.13 hours, respectively. Mean cumulative urinary excretion rates in the first 8 hours after administration were 51.2, 78.0 and 74.9%, respectively. 3. Ten patients with bacterial infections (pneumonia 5 cases, urinary tract infection 5 cases) were treated with CPR at a daily dose of 16-79 mg/kg/day. The overall clinical efficacy and bacteriological eradication rates were both 100%. 4. No adverse reactions were observed except in 1 case of mild pain in blood vessels. Abnormal laboratory test results were also mild, slight elevation of GOT, GPT and thrombocytosis in 1 case and eosinophilia in 1 case.

Sensitive photon detector based on selective laser ionization

A selective laser ionization photodetector (SLIP) is proposed and demonstrated. The SLIP uses an atomic-gas target as a detection element, instead of the photoelectric surface in photomultiplier tubes. The atomic gas resonantly absorbs the signal radiation to be detected and then is selectively photoionized by an intense laser beam. As a result, it can be expected that the SLIP will provide high quantum efficiency in a limited detection bandwidth. An analysis is made, and an initial-stage experiment on the SLIP is described.

[Acute cerebellar ataxia and facial palsy after DPT immunization]

Since the initial report of Beyers & Moll (1948), numerous cases of seizures and encephalopathy after pertussis immunization or DPT immunization have been reported. However, acute cerebellar ataxia and/or facial palsy after DPT immunization is unusual, although there have been several reports from Japan. We report a 1-year-11-month-old girl with acute cerebellar ataxia and facial palsy after DPT immunization. On admission, she was alert. She was active and had a 6-day history of an ataxic gait and asymmetric facial movement which had begun 5 hours after DPT immunization. Neurological examination revealed an ataxic gait, horizontal nystagmus and right facial palsy. A CT scan showed low density on the right side of the pons with marked contrast enhancement. A MRI scan indicated the involvement of not only the right side of the pons, but also of the bilateral cerebellar peduncles. The child did well subsequently and was neurologically normal 20 days after the initial symptoms. To our knowledge, the present case is probably the first reported one of acute cerebellar ataxia after DPT immunization with CT and/or MRI correlation.

[Retrograde coronary sinus perfusion of cardioplegic solution in Jatene operation in neonates and infants]

The clinical benefits of retrograde coronary sinus perfusion of a cardioplegic solution were investigated in 7 neonates and 23 infants undergoing Jatene operation. After an initial infusion of albumin-containing crystalloid cardioplegic solution via the aortic root, 21 patients received additional solution delivered by retrograde coronary sinus perfusion (retrograde group) and 9 patients received by selective antegrade coronary perfusion (antegrade group) every 20 to 30 minutes. There were no differences in age, weight, and left ventricular preoperative pressure and morphology between the two groups. Aortic cross-clamping time was 130 +/- 18 minutes in retrograde group and 147 +/- 20 minutes in antegrade group. Postoperative assays of CPK-MB, GOT and LDH, and hemodynamic measurements immediately after cessation of cardiopulmonary bypass (CPB) were carried out in all patients. Although there was no significant difference between the two groups in terms of enzyme indexes, retrograde group showed a greater variation of sigma CPK-MB from patient to patient than antegrade group. However, hemodynamic parameters of CVP, left atrial pressure and rate-pressure product at 20-30 minutes after CPB were similar in the two groups. Six neonates in retrograde group also demonstrated the similar enzyme indexes and hemodynamic state immediately after CPB to other older patients. We concluded, therefore, that retroperfusion of cardioplegic solution in neonates and infants provides satisfactory myocardial protection as well as antegrade perfusion, and it was a useful means of cardioplegic delivery in Jatene operation, because of its simplicity.