BMI is associated with larger index tumors and worse outcome after radical prostatectomy

BACKGROUND

To investigate the impact of body mass index (BMI) on tumor characteristics and biochemical recurrence (BCR) after radical prostatectomy (RP) for prostate cancer (PCa) in Japanese men.

METHODS

We evaluated data from consecutive patients who had undergone RP. Data analyzed included age, preoperative serum PSA, prostatic volume, BMI (continuous or categorized (≤ 25 kg/m(2)) values), clinical and pathological findings including index tumor volume (ITV), and current status in areas such as smoker or nonsmoker and presence or absence of diabetes. We analyzed association between BMI and BCR, especially based on ITV using univariate and multivariate analysis.

RESULTS

We analyzed data from a total of 703 patients. The median follow-up time was 38.4 months. BCR was diagnosed in 154 patients (21.9%) at a median of 9.7 months postoperatively. Multivariate linear regression analysis adjusted for preoperative variables showed a significant positive association between BMI and ITV (continuous BMI: P=0.002; categorical BMI: P<0.001, respectively), especially for higher-grade tumors (Gleason score ≥ 7). Cox proportional hazards analysis showed a significant association between continuous BMI and BCR after surgery (preoperative variables, hazard ratio (HR) 1.09, 95% confidence interval (CI) 1.02-1.16, P=0.008), independent of clinical and pathological findings. In patients with high-risk cancer, the positive association between BMI and BCR was strengthened (preoperative variables, continuous BMI, HR 1.16, 95% CI 1.07-1.26, P<0.001; categorical BMI, HR 2.11, 95% CI 1.29-3.45, P=0.003, respectively).

CONCLUSIONS

Greater BMI significantly correlates with higher rates of BCR after surgery; BMI is a preoperative variable associated with high-grade ITV. Our results suggest that the biological environment created by greater BMI may contribute to increasing tumor aggressiveness.

Successful treatment of monomorphic primary central nervous system post-transplantation lymphoproliferative disorder 5 years after kidney transplantation

A 31-year-old man underwent living-related kidney transplantation in 2004 as a consequence of primary focal segmental glomerulosclerosis (FSGS). Four years after the transplantation, we confirmed nephrotic syndrome caused by recurrent FSGS. We performed plasmapheresis and low-density lipoprotein adsorption. We also combined steroid therapy with a reduction in the dose of tacrolimus and an increased dose of mycophenolate mofetil. The nephrotic syndrome improved dramatically with this combined therapeutic approach. However, 10 months after these treatments, he revisited our hospital because of altered consciousness. We detected multiple tumor masses in his brain that were ring enhanced on contrast magnetic resonance imaging. Consequently, we suspected primary central nervous system post-transplantation lymphoproliferative disorder (CNS-PTLD). We performed a craniotomy to biopsy the brain tumors. The biopsy specimen showed Epstein-Barr virus-associated diffuse large B-cell lymphoma. There is no definitive treatment for CNS-PTLD. Therefore, we treated the primary CNS-PTLD successfully with whole-brain radiation and discontinuation of immunosuppression therapy.

Transient ligation of umbilical vessels elevates placental tissue oxygen index (TOI) values measured by near-infrared spectroscopy (NIRS) in clawn miniature pig animal model

We recently found a significant elevation in placental tissue oxygen index (TOI) values in cases of fetal growth restriction using near-infrared spectroscopy (NIRS), indicating high oxygenation in the placental tissue. We hypothesized that insufficient fetoumbilical blood flow is causatively associated with high oxygenation levels in placental tissue. We transiently (for 15 sec) ligated the whole umbilicus, umbilical arteries, or veins of pregnant Clawn miniature pigs (102-113 days of gestation) and assessed the changes in TOI values of the placenta and fetus. The ligation significantly increased placental TOI values (p<0.01, respectively), but concomitantly decreased fetal TOI values (p<0.01, respectively), suggesting a decline in oxygen inflow from the maternal to fetal circulation in the placental tissue to be causative of the elevated placental TOI values. These observations suggest the promising clinical use of placental TOI values measured noninvasively by the transabdominal application of NIRS to assess the fetoplacental circulation.

Relationship of Porphyromonas gingivalis with glycemic level in patients with type 2 diabetes following periodontal treatment

INTRODUCTION

The aim of this study was to assess the relationship between serum glycemic levels and subgingival microbial profile alteration following periodontal treatment in patients with type 2 diabetes mellitus.

METHODS

We studied 30 periodontitis patients with type 2 diabetes mellitus who received full-mouth subgingival debridement by analyzing their subgingival microbial profiles using a polymerase chain reaction method at baseline and various time-points for 12 months following treatment. Concurrently, probing pocket depth, bleeding on probing, and metabolic parameters, including glycated hemoglobin A1c (HbA1c), blood sugar level, C-reactive proteins, total cholesterol, triglyceride, and high-density and low-density lipoprotein cholesterol, were recorded.

RESULTS

Periodontal conditions were significantly improved after treatment, and the occurrence rates of periodontal bacterial species, including Porphyromonas gingivalis, Tannerella forsythensis, Treponema denticola, and Prevotella intermedia, were also reduced. Interestingly, P. gingivalis was detected more frequently in subjects with increased HbA1c values after periodontal treatment than in those patients with decreased HbA1c values. Furthermore, P. gingivalis with type II fimbriae was detected only in HbA1c-increased subjects, while improvements in HbA1c values were observed only in subjects without type II clones.

CONCLUSIONS

These results suggest that glycemic level in diabetes is affected by the persistence of P. gingivalis, especially clones with type II fimbriae, in periodontal pockets.

Morphological features of cartilage observed during mandibular distraction in rabbits

Ossification during distraction osteogenesis can be classified as intramembranous or endochondral. It is not known whether cartilage in the distraction gap is transformed into new bone. The aim of this study was to investigate the morphological features of ossification in the transition of cartilage to bone during mandibular distraction osteogenesis in a rabbit model. A cortical osteotomy was performed and custom-made devices were applied. Immediately after surgery, the devices were lengthened by 0.25 mm every 12h for up 10 days, during which time four rabbits were killed at 0, 5 and 10 days and examined using histological staining and immunohistochemical methods. Apoptotic cells were identified by an in-situ detection assay for nuclear DNA fragmentation using a modified TUNEL procedure, with several sections analyzed using software for histomorphometric analysis. The results showed that the amount of cartilage in the distraction gap was significantly decreased. The cartilage had ossified in two ways, termed endochondral ossification and transchondroid bone formation.

A simple method for bone positioning of mandibular segments

A simple bone-positioning technique is reported, using a combination of bone plates and a flexible tube filled with acrylic polymer. The flexible tube is solidified by injection of acrylic monomer. This technique is applicable for bone positioning after mandibular resection as well as positioning of the proximal segment after sagittal split ramus osteotomy. This technique has the advantages of greater simplicity and flexibility compared to previously reported methods of bone positioning.

Peripheral primitive neuroectodermal tumor of the vulva: report of a case with imprint cytology

BACKGROUND

Peripheral primitive neuroectodermal tumor (PNET) of the vulva is an extremely rare disease, and, to our knowledge, only two cases have been previously reported.

CASE

A 45-year-old woman presented with a mass in the right labium major. Three years after removal of the tumor, she noticed a new lesion in the same place and underwent a partial vulvectomy. The imprint cytology of the recurrent tumor showed a monomorphic appearance, composed of small round cells with scant cytoplasm against a hemorrhagic background. These tumor cells were loosely connective, but rosettelike structures were observed focally. On pathologic examination, the neoplasm was composed of small round tumor cells showing sinusoidal, diffuse or micropapillary growth. Immunohistochemically, the neoplastic cells stained positively for neuron-specific enolase, vimentin and HBA 71 and negatively for cytokeratin, HBA 45 and muscle-specific actin. The morphologic characteristics of the disease were well expressed in the imprint cytology, and this influenced the selection of immunohistochemical studies.

CONCLUSION

Cytologic examination for vulvar tumors, even imprint cytology, can be a useful tool in obtaining an accurate pathologic diagnosis of a rare disease, such as peripheral PNET.

Initial experience of percutaneous renal cryosurgery under the guidance of a horizontal open MRI system

OBJECTIVE

The aim of this study was to obtain preliminary results of cryoablation of renal tumors by using a percutaneous approach guided by a horizontal open MRI system, and to assess the safety and efficacy of this procedure.

MATERIALS AND METHODS

Four patients with renal tumors underwent percutaneous cryosurgery with local anesthesia using a horizontal open MRI system (AIRIS II, Hitachi Medical Corp., Tokyo, Japan). The size of the mass was radiographically documented as 4 cm or less in diameter. A 2- or 3-mm cryoprobe was advanced into the renal mass under real-time MR monitoring. Growth of the iceball during cryoablation was monitored by two-dimensional MR images. Follow-up dynamic CT and physical examination were done after two weeks and six weeks.

RESULT

MR imaging demonstrated the iceballs as sharply marginated regions of signal loss that expanded and engulfed the renal mass with clear contrast between the iceball and surrounding tissue. Cryoablated tumors resolved, and there were no serious complications and no clinically significant changes during the procedures and follow-up study.

CONCLUSION

In this limited clinical trial of percutaneous renal tumor surgery, cryoablation demonstrated its feasibility with minimal morbidity. Intraprocedual MR-guided cryosurgery can be used as a safe modality, although further studies are necessary to determine the long-term efficacy of this procedure.

[Pulmonary infarction caused by the spontaneous migration of the vena caval tumor thrombus of right renal cell carcinoma: a case report]

A 70-year-old male with right renal mass incidentally found by annual check-up using ultrasound, was referred to Department of Urology, Jikei University Affiliated Kashiwa Hospital. He was diagnosed as having right renal cell carcinoma with vena caval tumor thrombus extending above the diaphragm (T3c) preoperatively. The day before the scheduled day of operation, right pulmonary infarction caused by spontaneous migration of vena caval tumor thrombus of right renal cell carcinoma developed. Although arterial blood gas findings were poor, he only had low grade chest pain without shock. Therefore, we successfully performed right radical nephrectomy and thrombectomy of right pulmonary artery the next day. He was discharged 42 days postoperatively, but, he died from acute heart failure 9 months after the operation.

Application of high-surface-area ZrO2 in preconcentration and determination of 18 elements by on-line flow injection with inductively coupled plasma atomic emission spectrometry

A flow-injection analysis (FIA) system incorporating a micro-column of ZrO2 has been used for the development of an on-line multi-element method for the simultaneous preconcentration and determination of Al, Bi, Cd, Co, Cr, Cu, Fe, Ga, In, Mn, Mo, Ni, Pb, Tl, V, Sb, Sn, and Zn by inductively coupled plasma atomic emission spectrometry (ICP-AES). The conditions for quantitative and reproducible preconcentration, elution, and subsequent on-line ICP-AES determination were established. A sample (pH 8) is pumped through the column at 3 mL min(-1) and sequentially eluted directly into the ICP-AES with 3 mol L(-1) HNO3. With a sample volume of 100 mL and an elution volume of 1 mL signal enhancement 100 times better than for conventional continuous aspirating systems was obtained for the elements studied. The reproducibility (RSD %) of the method at the 10 ng mL(-1) level in the eluate is acceptable - less than 8% for five replicates. Recoveries between 95.4% and 99.9% were obtained for the elements analysed. ZrO2, with a specific surface area of 57 m2 g(-1) and a capacity of approximately 5 mg g(-1) for the elements studied, was synthesized by hydrolysis of ZrCl4. The preconcentration system was evaluated for several simple synthetic matrices, standard water samples and synthetic seawater. The effect of foreign ions on the efficiency of preconcentration of the elements studied was investigated. The application of a micro-column filled with high-surface-area ZrO2 and flow injection inductively coupled plasma atomic emission spectrometry enables preconcentration and simultaneous determination of 18 elements at low concentrations (ng L(-1)) in different water samples.

[Clinical statistics on patients and operations during a 20-year period (1978-1997) at Department of Urology, Jikei University School of Medicine]

A statistical analysis was made of diseases, patients, and operations at our department in the four affiliated hospitals of Jikei University School of Medicine from 1978 through 1997. Our findings were as follows. Newly diagnosed urogenital malignancies, except testicular tumors, have been increasing in the last two decades among both outpatients and inpatients. Urogenital infections, including tuberculosis, have gradually been decreasing in the last two decades. The treatment of urinary stone diseases was markedly altered by the induction of extracorponeal shock wave lithotripsy.

[A case of patent urachus in an adult male]

A 31-year-old man was referred to our hospital for evaluation of urachal rest. The history of his present illness dated back to birth, when the umbilicus was projected and urinary discharge was noted. At that time, the symptom of discharge had spontaneously subsided. At the age of 22, however, the patient again experienced discharge from the umbilicus. Although he did not seek treatment, after six years this symptom disappeared. Around this time, however, pyuria was revealed during medical examination, and abdominal ultrasonography (US) suggested the presence of urachal rest. At the time of hospitalization, physical examination revealed that the patient's right testis was not palpable. He was diagnosed with patent urachus with hemilateral aplasia and monorchism by US, computed tomography, magnetic resonance imaging and cystoscopy. The patient subsequently underwent radical operation. Patent urachus in adults is very rare, and only a few cases have been reported. To our knowledge, only one previously reported case involved a recurrence after spontaneous healing. Further, this is the first report of a patient with patent urachus with hemilateral aplasia and monorchism. Radical operation is generally recommended, based on the fact that very few cases heal conservatively.

[A case of Sipple syndrome whose bilateral pheochromocytomas were resected separately after a 3-year interval]

A 23-year-old woman who had undergone total thyroidectomy and parabronchial lymphadenectomy at the Department of Otolaryngology in our hospital was suspected to have a thyroid carcinoma. Histological examination revealed a medullary carcinoma of the thyroid and normal parathyroid glands. Because a computed tomographic scan after surgery revealed a tumor of the left adrenal gland, the patient was examined at our department two months after the thyroidectomy, 1994. Endocrinic examinations and 123I-MIBG scintigraphy revealed a left adrenal pheochromocytoma of Sipple syndrome. She then underwent left adrenalectomy. Histological diagnosis was pheochromocytoma of the left adrenal gland. Three years after the surgery, a right adrenal tumor was detected by computed tomography. Although results of endocrine examinations were normal, 131I-MIBG scintigraphy showed a hot spot in the right adrenal gland. Right adrenal pheochromocytoma was diagnosed 3 years after surgery for a contralateral adrenal pheochromocytoma. Although surgery was recommended, the patient consented to right adrenalectomy, 1 year later after marriage and before becoming pregnant. Histological examination of the resected specimen revealed pheochromocytoma of the right adrenal gland.

Speciation of selenium compounds with ion-pair reversed-phase liquid chromatography using inductively coupled plasma mass spectrometry as element-specific detection

For selenium speciation analysis, the hyphenation of chromatographic separation with element-specific detection has proved a useful technique. A powerful separation system, which is capable of resolving several biologically and environmentally important selenium compounds in a single column, is greatly needed. However, that has been difficult to achieve. In this paper eight selenium compounds, namely, selenite [Se(IV)], selenate [Se(VI)], selenocystine (SeCys), selenourea (SeUr), selenomethionine (SeMet), selenoethionine (SeEt), selenocystamine (SeCM) and trimethylselenonium ion (TMSe+), were separated by using mixed ion-pair reagents containing 2.5 mM sodium 1-butanesulfonate and 8 mM tetramethylammonium hydroxide as a mobile phase. The separation of these anionic, cationic and neutral organic selenium compounds on a LiChrosorb RP18 reversed-phase column took only 18 min at a flow-rate of 1.0 ml/min with isocratic elution, and baseline separation among the six organic Se compounds was achieved. Inductively coupled plasma mass spectrometry (ICP-MS) was employed as element-specific detection. A comparison of ICP-MS signal intensity obtained with a Barbington-type nebulizer and with an ultrasonic nebulizer (USN) was made. Different signal enhancement factors were observed for the various selenium compounds when a USN was used. The speciation technique was successfully applied to the study on chemical forms of selenium in a selenium nutritional supplement. Selenomethionine was found to be the predominant constituent of selenium in the supplement.

[Clinical efficacy of cefpirome sulfate against Bacteroides species, Prevotella species and Porphyromonas species. Society of Anaerobic Bacterial Infections in the fields of obstetrics and gynecology in Gifu]

The injectable cephalosporin cefpirome (CPR) was launched in Japan in 1993. It has widely been used in the various infectious diseases. We therefore studied the clinical and bacteriological efficacy of CPR against infections caused by Bacteroides species, Prevotella species and Porphyromonas species frequently isolated from the obstetric and gynecologic infections. Thirteen institutions were involved in this study which ran from March 1994 to January 1999. The administration dosage of CPR was 2 to 4 gram per day administered by drip infusion or intravenous infusion. The duration of treatment was from 3 to 15 days. The evaluations were performed before and after the treatment. CPR was administered to 194 patients with obstetric and gynecologic infections, and 146 of 194 cases were acceptable for the evaluation of drug efficacy. Bacteroides species were identified in 102 patients. Clinical efficacy in 146 cases was excellent in 12 patients, good in 110, fair in 9 and poor in 15 patients. The eradication rate for Bacteroides species could be in 37 cases out of 54 evaluable cases; Prevotella species in 38 out of 49; and Porphyromonas species in 5 out of 5. The overall assessment of bacteriological efficacy was "eradicated" in 91 cases out of 133 (68.4%). Adverse reactions including abnormal findings in laboratory tests were seen in 8 patients (4.76%). Based on these results, CPR promises efficacy and safety in the treatment of obstetric and gynecologic infections due to Bacteroides species.

[Clinical studies on inverted papilloma of the urinary tract]

BACKGROUND

Inverted papilloma of the urinary tract is believed to be a benign neoplasm based on its histologic morphology and clinical behavior. In recent years, however, several investigators have warned against too optimistic an approach, emphasizing the possibility of malignant cellular transformation within the lesion, or its eventual association with other urothelial tumors such as transitional cell carcinoma or carcinoma in situ. We here report on 35 clinicopathologically diagnosed cases of inverted papilloma, and present the clinical significance attributed to these lesions in view of the current literature.

PATIENTS AND METHODS

From 1976 to 1997, 35 cases of inverted papilloma of the urinary tract were treated at our hospital. This report presents the clinical features of these cases, the results of prognosis research, an investigation of the cases in which inverted papilloma and transitional cell carcinoma were found to co-exist, and a discussion of the recurrent cases of inverted papilloma found in previous literature.

RESULTS

The patients ranged from 24 to 77 years of age, with a mean of 54 years, and included 4 women and 31 men. The most frequently occurring symptom was grosshematuria, and more than 90% of the 35 cases occurred in the bladder. In 2 of the 35 cases, transitional cell carcinoma coexisted with the inverted papilloma, at a different location in the bladder in one case and within the same neoplasm in the ureter in the other case. Clinical courses after treatment were followed in 29 of the 35 cases, with a follow-up period of from 8 months to 19 years (mean follow-up, 5 years and 4 months). Of these 29 cases, 2 showed recurrence, one at 16 and one at 30 months after the initial resection. Many previous reports show that the association of inverted papilloma and transitional cell carcinoma is stronger in the upper urinary tract and recurrence of inverted papilloma almost always happens with 2 years.

CONCLUSION

This study suggests that some cases of urinary inverted papilloma show recurrence or malignant potential. Our results indicate that all cases of urinary inverted papilloma should be treated and followed as cases of low-grade transitional cell carcinomas. Consequently, all cases must be followed for two years or more after the initial operation.

Diagnosis of pheochromocytoma using [123I]-compared with [131I]-metaiodobenzylguanidine scintigraphy

BACKGROUND

Patient with pheochromocytoma (PCT) cannot be cured without operation, therefore, preoperative determination of the localization of PCT should be performed accurately. [131I]-Metaiodobenzylguanidine (MIBG) scintigraphy is a gold standard for the diagnosis of PCT. However, [123I]-MIBG is also found to accumulate in PCT. In order to clarify the usefulness of [123I]-MIBG scintigraphy for the local detection of PCT, we compared the distribution of [123I]- and [131I]-MIBG in patients with or without PCT.

METHODS

[131I]- and [123I]-MIBG scintigraphy was performed in 29 and 16 patients, respectively. In the former group, 14 patients had PCT, 12 had hypertension without any adrenal disorder and three had other diseases. In the latter group, eight patients had PCT, two had hypertension without any adrenal disorder and six had other diseases. The sensitivity, specificity and accuracy of [123I]-compared with [131I]-MIBG scintigraphy were compared.

RESULTS

The sensitivity of [131I]- and [123I]-MIBG scintigraphy was 85.7 and 90%, respectively. The specificity of each test was 100%. The accuracy of [131I]- and [123I]-MIBG scintigraphy was 93.1 and 95%, respectively. The quality of images obtained using [123I]-MIBG was better than with [131I]-MIBG, because [123I]-MIBG generated a higher dose of gamma-rays with a higher specificity than [131I]-MIBG. In addition, normal adrenal grands were visualized in 50% of patients tested with [123I]-MIBG scintigraphy.

CONCLUSIONS

These results indicate that [123I]-MIBG scintigraphy is a valuable tool for the local detection of PCT, as is [131I]-MIBG scintigraphy. Furthermore, it is possible that [123I]-MIBG can be used as an alternative to [131I]-MIBG for the detection of PCT. Our study was not a prospective study and the background of the patients was not matched. Further prospective studies are needed in order to determine the efficacy of [123I]-MIBG scintigraphy for the diagnosis of PCT.

[Magnetic resonance images of hematospermia]

BACKGROUND

We performed MRI (magnetic resonance imaging) in the pelvic region of 70 cases with hematospermia and conducted a study on the abnormal MRI findings to which hematospermia could be attributed.

METHODS

We conducted a study on the morphological anomaly and change in the signal intensity in the prostate gland and of the seminal vesicle as well as on the presence or absence of dilation in the plexus venous surrounding the deferent duct or the prostate gland out of the abnormal MRI findings. As for the seminal vesicle, the patients whose seminal vesicle was seen in higher intensity than the prostate gland in T1 weighted images were diagnosed as having hemorrhagic focus and the patients whose seminal vesicle was seen in low intensity both in T1 and T2 weighted images were diagnosed as having fibrosis caused by chronic inflammation.

RESULTS

Abnormal MRI findings were seen in 40 out of the 70 cases (57%). Anomaly in the prostate gland was indicated in 6 (9%) cases. Abnormality in the seminal vesicle was indicated in 30 cases (43%) including hemorrhage of seminal vesicle in 25 cases, chronic inflammation in five cases and cyst of seminal vesicle in one case.

CONCLUSION

In conducting an examination of the patients with hematospermia, MRI is the noninvasive and reproducible method and it is possible to identify the hemorrhagic region. Therefore, MRI is thought to be useful to identify the causal organs of hematospermia.

Isotope dilution analysis of Se in human blood serum by using high-power nitrogen microwave-induced plasma mass spectrometry coupled with a hydride generation technique

To establish a method for sensitive, accurate, and precise determination of Se in real samples, isotope dilution analysis using high-power nitrogen microwave-induced plasma mass spectrometry (N2 MIP-IDMS) was conducted. In this study, freeze-dried human blood serum (Standard Reference Material, NIES No. 4) provided by NIES (National Institute for Environmental Studies) was used as a real sample. The measured isotopes of Se were 78Se and 80Se which are the major isotopes of Se. The appropriate amount of a Se spike solution was theoretically calculated by using an error multiplication factor (F) and was confirmed experimentally for the isotope dilution analysis. The mass discrimination effect was corrected for by using a standard Se solution for the measurement of Se isotope ratios in the spiked sample. However, the sensitivity for the detection of Se was not so good and the precision of the determination was not improved (2-3%) by N2 MIP-IDMS with use of the conventional nebulizer. Therefore, a hydride generation system was connected to N2 MIP-IDMS as a sample introduction system (HG-N2 MIP-IDMS) in order to establish a more sensitive detection and a more precise determination of Se. A detection limit (3 sigma) of 10 pg mL-1 could be achieved, and the RSD was less than 1% at the concentration level of 5.0-10.0 ng mL-1 by HG-N2 MIP-IDMS. The analytical results were found to be in a good agreement with those obtained by the standard addition method using conventional Ar ICPMS.

Impairment of autonomic function induced by posture change in postmenopausal women

This study was designed to determine if there is a difference in autonomic regulation induced by posture change between postmenopausal and young women. To evaluate autonomic nervous system function, spectral analysis of heart rate variability (HRV) was done in postmenopausal women (n = 13, 46-59 years of age), age-matched men (n = 8, 45-55 years of age), and young women (n = 10, 20-37 years of age) for 3-min periods of controlled frequency breathing (15 breaths/min) in supine followed by sitting positions. In the supine position, the R-R interval variation in older persons decreased significantly compared with that during the follicular phase in young women. Furthermore, the high-frequency (HF) components of HRV, which reflect only parasympathetic activity, were lower in older subjects than in young women. Following a change of position from supine to sitting, the HF component did not change significantly in the postmenopausal women or the men, but the low/high frequency (LF/HF) component ratio, which reflects the balance of autonomic nerve activities, increased significantly in the men. These results suggest that cardiac parasympathetic tone may be reduced in older persons in comparison with young women. Furthermore, arterial baroreflex control of parasympathetic nerve activity caused by posture changes is impaired in the postmenopausal women and aged-matched men. The baroreflex control of the sympathetic component is maintained in the men but not in the postmenopausal women. These differences might result in part from changes in the level of female hormones.

Visual evoked potential and electroencephalogram of healthy females during the menstrual cycle

Flash visual evoked potential (VEP) and electroencephalogram (EEG) changes during the menstrual cycle were studied using healthy females having regular menstruation, with 21 at the follicular phase (FP) and 23 at the luteal phase (LP). The following results were obtained. (1) The waveforms of Group Mean VEPs of both groups had approximately similar triphasic contours, consisting of 16 components of P 1-N 8 up to 500 msec of latency. (2) Latencies tended to be longer in LP. (3) Interpeak amplitudes tended to be larger in LP, and one VEP interpeak amplitude (P 5-N 7) of long latency component was significantly larger at LP after eliminating the effect of body height by ANCOVA for 2 CH. (4) Quantitative analysis of EEGs between FP and LP resulted in a tendency for increased alpha, and decreased beta power % at LP. Since estrogen increases the VEP amplitude, and decreases the VEP latency and the alpha activity of EEGs, the large VEP amplitude, the tendency for prolonged VEP latency, and the tendency for increased alpha power % at LP observed in this study indicate that the VEP amplitude at LP reflects the effect of estrogen, and that the VEP latency and EEGs at LP reflect the effect of progesterone.

Sex differences in visual evoked potential and electroencephalogram of healthy adults

Sex differences in flash visual evoked potentials (VEPs) and electroencephalograms (EEGs) were studied in 200 healthy adults (100 females and 100 males). Following results were obtained. (1) Waveforms of Group Mean VEPs of each sex had roughly triphasic contour, consisted of components P1 approximately N8, within 500 msec of latency. (2) Latencies of VEP components by t-test, (3) By analysis of covariance, sex differences in peak-to-peak amplitudes were still significant after eliminating effects of body height, body weight or age, but not those in latencies after eliminating the effect of body height. (4) Quantitative analysis of EEGs resulted in significantly smaller absolute amplitudes, and significantly larger theta, larger beta 1 and smaller alpha 2 power % in females. (5) Peak-to-peak amplitudes of later components in VEPs for 5CH (O1-->Cz) were significantly and positively correlated with EEG absolute amplitudes within each sex group. (6) There were few significant differences in VEP components between follicular phase and luteal phase in females. The sex differences in VEPs verified in this study may be attributed to genetically determined sex differences in neuroendocrinological systems.

Determination of different oxidation states of arsenic and selenium by inductively coupled plasma-atomic emission spectrometry with ion chromatography

Recent regulation in Japan requires more sensitive trace analysis methods for the determination of arsenic and selenium and their oxidation states As(III) and (V), Se(IV) and (VI). The hydride generation (HG) technique is usually used in combination with AAS and ICP-AES to increase sensitivity. However, hydrochloric acid is mostly used to acidify the sample solution in HG. Isobaric interferences due to chlorine-related species cause mass spectral problems when the same solution is used for the determination of these elements by ICP-MS. In this study, different oxidation states of As and Se were determined by coupling ion chromatography (IC) to an ICP-AES instrument. An HG technique was used to introduce test samples into the ICP. Nitric acid was employed to acidify the samples for HG. The concentrations of acid and base were kept as low as possible to reduce contamination. The formation of As and Se hydrides could be achieved without HCl, if the concentrations of acid and alkaline solutions were optimized. However, HCl was necessary for additional reduction of Se(VI) to Se(IV).

Renal gluconeogenesis in man: comparison with rats and rabbits

To provide evidence on renal gluconeogenesis in humans and to compare with rats and rabbits, glucose production from several substrates was determined using cortical slices of the three species. In humans, the normal parts of kidney tissue were obtained from six cases of transitional cell carcinoma of the renal pelvis and four cases of renal cell carcinoma. Renal cortical slices were incubated aerobically with or without substrates, and the glucose contents were assayed photometrically. The specificity of human kidneys was evaluated by comparison with the results obtained from rats and rabbits. The rank order of renal gluconeogenesis from various substrates was as follows: Humans: pyruvate > oxaloacetic acid > lactic acid > fructose-1,6-diphosphate > L-glutamine. Rats: pyruvate > fructose-1,6-diphosphate > oxaloacetic acid > lactic acid > L-glutamine. Rabbits: fructose-1,6-diphosphate > pyruvate > oxaloacetic acid > lactic acid >> L-glutamine = 0. In general, the human kidney can produce glucose at the lowest rate among the three species. The substrate specificity of humans was more or less similar to that of rats. These results suggest the existence of a species difference in renal gluconeogenesis both in substrate specificities and quantitative activities.

[Study on gamma-GTP activity in urine and renal tissue of drug-induced nephrotoxicity in rats]

We investigated changes of urinary and renal gamma-glutamyl transpeptidase (gamma-GPT) activities in rat with renal damages caused by nephrotoxic agents in order to clarify the onset and the course of these nephrotoxicities. Cisplatin (CDDP) which is an antitumor agent, cephaloridine (CER) which is the first-generation cephem, and gentamicin (GM) which is an aminoglycoside were employed as tested nephrotoxic agents. We administered three fourth of LD50 of each agent to male Fischer 344 rats, intra-peritoneally. And the time-course changes of serum creatinine (s-Cr) value, creatinine clearance (Ccr) and urinary gamma-GTP activity were observed after administration of each agent. Finally, we measured renal gamma-GTP activities and observed pathological changes of the kidneys. The elevation of s-cr values and the reduction of Ccr appeared 3 days and 12 hours after the administration of CDDP and CER, respectively. And the peak appeared 7 days and 3 days after the administration of CDDP and CER, respectively. Increase of urinary gamma-GTP activities occurred earlier than the peak of s-cr value and Ccr in each group and as early 12 hours after the administration. In CER groups, the peak of urinary gamma-GTP activities was observed within 12 hours after the administration. And the peak of urinary gamma-GTP activities was observed at 24 hours and in 3 days after the administration of GM and CDDP, respectively. In addition, renal gamma-GTP activities reduced around 40% of those of control.(ABSTRACT TRUNCATED AT 250 WORDS)

[Determination and clinical significance of human hepatocyte growth factor in serum]

Hepatocyte growth factor (HGF) is the most potent mitogen for mature parenchymal hepatocytes in primary culture, and seems to be a hepatotrophic factor that acts as a trigger for liver regeneration after partial hepatectomy and liver injury. In the present study, we evaluated an enzyme-linked immunosorbent assay, using monoclonal antihuman HGF (h-HGF) antibody, for measuring serum h-HGF levels. Intra- and inter-assay coefficients of variation were 2.2-3.3% and 3.4-4.0%, respectively. Detection limit of this method was 0.1 ng/ml, determining by the dilution test. The substances tested did not interfere with this assay, except for high concentrations of hemoglobin. Furthermore, no interference was observed with plasminogen and lipoprotein (a), which show the structural homology to h-HGF, and with various kinds of cytokines. Reference ranges of serum h-HGF determined with 187 healthy subjects were 0.1-0.23 ng/ml. Serum h-HGF concentrations were increased in various kinds of liver diseases, in particular those were significantly higher in fulminant hepatic failure. Furthermore, prognosis of the patients with higher h-HGF values were strikingly worse than those with lower levels. We concluded that the determination of serum h-HGF plays important roles in the early diagnosis and prognosis of fulminant hepatic failure.

[A study on the passage of the upper urinary tract stones after in situ ESWL]

Two hundred patients with upper urinary tract stones underwent in situ ESWL with Lithostar during the recent 20 months at Kanagawa Prefectural Atsugi Hospital. Actual residual stone rates were calculated based on the period from the initiation of the treatment to the stone free status, and discussed according to the location and size of the stone treated. Total 200 patients were submitted to 1.67 +/- 0.97 treatment sessions with 6742 +/- 5545 shock waves. After 3 months, 148 patients (78%) showed stone free status, and 32 patients (16%) had residual stones less than 4 mm. The actual residual stone rates were 90.5%, 66.5%, 39.1%, 26.9% and 17.9% after 1, 3, 6, 12 and 20 weeks, respectively. The residual stone rate were lower in the lower ureter, uretero-pelvic junction, upper ureter, renal parenchyma or diverticulum and renal pelvis or calyx in order. As for the size, the larger the stones the higher the residual stone rates; the therapeutic results were significantly worse in patient group of stones larger than 21 mm compared to the patient group of smaller stones (p less than 1%). The destructed stones were passed gradually up to 6th week after in situ ESWL, however, after that fragments seldom passed out. Therefore, it was concluded that decision on the additional or combination therapeutic intervention, if necessary, should be made after 6 weeks. Combination therapy with endoscopic surgery and/or others was seemingly needed for the patients with stones of more than 21 mm in size and of renal pelvis and renal calyx to improve the rates of stone free.

Adjuvant chemotherapy with vinblastine, adriamycin, and UFT for renal-cell carcinoma

VAU therapy (vinblastine, Adriamycin, and UFT) was given postoperatively to 31 patients with stage I, II, or III renal-cell carcinoma, and the incidence of relapse as well as the survival of patients were studied. Administration was started at 7-14 days post-surgery; 5 mg/m2 vinblastine and 30 mg/m2 Adriamycin were given i.v. once every 4 weeks for a total of five courses, and three capsules of UFT (containing 300 mg tegafur) were given p.o. every day for 2-3 years. The postoperative observation period ranged from 2 years and 6 months to 7 years and 1 month (mean, 4 years and 2 months). The 1-year survival of patients was 100%, and the 3- and 5-year survival values were 96%. These results were significantly better (P less than 0.01) than the respective values (81%, 72%, and 60%) obtained for the historical controls, i.e., the 60 patients with stage I, II, or III renal-cell carcinoma who received no chemotherapy. Side effects such as alopecia, gastrointestinal symptoms, and myelosuppression were encountered, but all symptoms were so mild and transient that discontinuation of the treatment was not necessary. As VAU therapy might be useful as adjuvant chemotherapy for renal-cell carcinoma, it seems to merit further study.

[A case of mesothelioma of perinephric space origin]

Cystic mesothelioma of perinephric retroperitoneum origin are very uncommon tumors and considered potentially malignant. We report one such case and discuss the clinical and pathological findings. A 70-year-old man was seen with complaint of discomfort in the right flank and hospitalized in May 1989. Computerized tomography revealed multiple cystic masses in the right retroperitoneal space which appeared to be infiltrating the kidney and the iliopsoas muscles. Magnetic resonance imaging showed deformation of the right kidney with many impressions in the parenchyma. The cystic lesions and the right kidney were extirpated on June 2, 1989. Grossly the specimen was 16 x 10 x 8 cm in size and 630 g in weight. The multiple cysts surrounding the kidney were each approximately 10 mm in diameter and had thin outer walls. The cyst fluid was clear and serous. The kidney had not been infiltrated but had only external impressions caused by the cystic lesions. Microscopically, the cysts were lined by a single layer of cuboidal cells accompanied by some hobnail-shaped cells, and no evidence of malignancy was found. The epithelium was focally positive for periodate acid Schiff and slightly positive for Alcian blue. It was strongly positive for cytokeratin and vimentin, and slightly positive for EMA but negative for lectins. The diagnosis was diffused benign multicystic mesothelioma. However, CT taken four months after the operation revealed local recurrence and radiotherapy (40 Gy) was instituted. Since the cystic mass tended to grow in size thereafter, the lesion appeared to be malignant clinically. We consider this is the first case of cystic mesothelioma of perinephric retroperitoneum origin reported in Japan.

[A clinical study of associated bladder cancer in patients with renal pelvic and ureteral cancer]

Retrospective study on the frequency of associated bladder cancer and the influence on the prognosis was carried out in 170 cases of renal pelvic and ureteral cancer. The number of cases of associated bladder cancer coexistent with renal pelvic and ureteral cancer was 31 (18.2%), and the number of subsequent cases 3 (19.4%). The frequency of occurrence of the primary tumor site was 27.2% in the renal pelvis, 45.6% in the ureter and 58.3% in both renal pelvis and ureter. Multiple tumors occurring in the renal pelvis and ureter occupy a high percentage. As for the degree of differentiation, many cases were subsequent to G1. As for the stage, a few cases with bladder cancer were subsequent to T4, but there was no definite tendency in the occurrence of bladder cancer. The prognosis of renal pelvic and ureteral cancer: the 10-year survival rate was 93.3% for G1, 66.6% for G2 and 12.4% for G3. As can be seen, there was good correlation with the pathological gradings. It must be remembered, however, that 5-year survival rates in cases of associated bladder cancer of coexistent type, in cases of subsequent type and in cases without associated bladder cancer were 56.2%, 72.7% and 64.8%, respectively: there was no significant difference. Bladder cancer associated with renal pelvic and ureteral cancer makes the therapy troublesome, but no influence on the prognosis was observed. Therapy in conformity with the pathological grading and stage is regarded as particularly important in cases of associated bladder cancer.

[Clinical and pathological studies on incidental renal cell carcinoma]

During the five-year period from 1985 to 1989, a total of 69 patients with renal cell carcinoma received treatment at Daisan Hospital of Jikei University School of Medicine. Among these patients, there were 23 patients (33.3%) with incidental renal cell carcinoma. These 23 cases were studied clinically and pathologically in comparison with 46 symptomatic cases. The tumor was detected by ultrasonography (US) or computed tomography (CT) conducted for the diagnosis of other diseases in 16 cases and by US included in the battery of physical examinations in the remaining 7 cases. As compared to symptomatic cases, less hematological abnormalities were found in these cases, since ESR was accelerated in only 2 cases and anemia and elevation in alpha 2-globulin level were found in none of the cases. As for diagnostic imaging, CT could detect the tumor in all of 23 cases and US in 20 out of 21 cases. Intravenous pyelography gave normal pyelograms in 4 cases. Normovascular findings were obtained by renal angiography in 2 cases. The mean largest diameter of tumors of these 23 cases was 3.9 cm, being smaller than the corresponding mean diameter of 7.7 cm for symptomatic cases. In 8 out of 23 cases tumors were small renal cell carcinoma of 2.5 cm or less in diameter. Pathologically, incidental renal cell carcinoma was characterized by small size, expansive growth pattern (INF alpha in 18 cases and INF beta in 5 cases) and prevalence of clear cell subtype (clear cell subtype in 18 cases, granular cell subtype in 2 cases and mixed cell subtype in 3 cases).(ABSTRACT TRUNCATED AT 250 WORDS)

[Adjuvant chemotherapy with vinblastine, adriamycin and UFT (VAU) for renal cell carcinoma]

We tried adjuvant chemotherapy with vinblastine, adriamycin, and UFT on thirty-one renal cell carcinoma patients in stage I, II or III to determine whether or not it might improve their survival rate. The patients were started on adjuvant chemotherapy with vinblastine 5 mg/m2 i.v. and adriamycin 30/m2 i.v. 7 to 14 days after surgery, and drugs were administered every 4 weeks for a total of 5 times. UFT was administered orally in a dose of 3 capsules (300 mg as tegafur) daily for 2 to 3 years. The postoperative period averaged 4 years and 2 months with a range of 2 years and 6 months to 7 years and 1 month. The 1-year survival rate for the 31 patients was 100%, and 3- and 5-year survival rates were 96%. These results were encouraging, compared to the 1-, 3-, and 5-year survival rates of 81%, 72% and 60% achieved in a series of 60 renal cell carcinoma patients in stage I, II or III without adjuvant chemotherapy. Side effects such as alopecia, gastrointestinal symptoms, and myelosuppression were observed, but all symptoms were so mild or transient that the treatment could be continued in the patients.

[A case of malignant pheochromocytoma of the urinary bladder]

A 31-year-old man was admitted to our hospital because of miction pain and gross hematuria in August, 1988. Cystoscopic examination revealed a solid mass in the bladder. The histological diagnosis was pheochromocytoma of urinary bladder by biopsy. He had a history of syncope on urination several times. Abnormal elevation of serum noradrenaline was observed in hormonal studies and abnormal accumulation was seen in the bladder by 131I-MIBG scintigraphy. Total cystectomy, lymphadenectomy and urinary diversion were performed in November, 1988. Pathological diagnosis was pheochromocytoma of the urinary bladder with metastasis to both iliac lymph nodes.

[In vivo anti-tumour efficacy of tumour necrosis factor and interferon- alpha, -gamma on human renal cell carcinoma heterotransplanted in nude mice]

Using human renal cell carcinoma heterotransplanted in nude mice (JRC 11: anaplastic and alveolar pattern, grade IV), the in vivo anti-tumour efficacy of tumour necrosis factor (rHu-TNF-alpha: PT-050) and IFN-alpha (nHu-IFN-alpha: HLBI), IFN-gamma (nHu-IFN-gamma: OH-6000) were investigated. The dose of TNF was 1,000, 3,000, 10,000 J.R.U. (i.p., every day), that of IFN-alpha was 1 x 10(4) and 1 x 10(5) I. U. (s.c., every day) and that of IFN-gamma was 1 x 10(4) and 1 x 10(5) I.U. (s.c., every day). Mono-therapy of TNF, IFN-alpha and IFN-gamma was not effective with regard to tumour regression rates, histological degeneration rates and survival time of the host mice. Combination therapy of TNF and IFN-alpha, IFN-gamma were also not effective with regard to tumour regression rates, but when considering histological change, sporadic disappearance of endothelium of intra-tumoural vasculature, flow of tumour cells clustered in intra-vascular cavity, and extra-vascular bleeding were observed. With special reference to survival of host mice, prominent prolongation of survival time in combination treatment, especially in TNF combination therapy groups with the dosage of 10,000 J.R.U. was observed. Therefore we concluded that there is no synergistic reaction in combination therapy of TNF and IFN against JRC 11 tumour. But combined activity of TNF and IFN on the vasculature of renal cell carcinoma (JRC 11) and the suppression of cachexia related condition were detected.

[Comparative study of the patients with renal cell carcinoma before and after 1980]

Patients with renal cell carcinoma treated at Jikei University and affiliated institutions were studied with regard to temporal differences. Our study population was divided into two groups: an earlier group comprising 169 patients treated between January 1957 and December 1979, and a later group comprising 165 cases treated between January 1980 and December 1984. The mean age in the earlier group was 56.2 years, while that in the later group was 60.4 years. Therefore, the patients in the earlier group were generally younger than those in the later group. Patients in the earlier group were more likely to present with urinary symptoms at the time of diagnosis. On the other hand, patients in the later group were more likely to present with extra-urinary symptoms or to be asymptomatic. The time period between the onset of symptoms and initial consultation with physician was longer (within one month) in the earlier group. Most patients in the later group underwent nephrectomy using the transperitoneal or thoracoabdominal approach. Few patients in the later group were treated with radiotherapy. As adjuvant chemotherapy, MFC (MMC, 5-FU and Ara-C) or MACV (methotrexate, actinomycin D, cyclophosphamide and vincristine) regimen were most commonly employed in the earlier group. FAV (5-FU, adriamycin and vinblastine) regimen or interferon therapy which was classified as biological response modifiers (BRM) were more commonly employed in the later group. More cases were diagnosed as stage II in the earlier group, and more cases were diagnosed as stage IV in the later group. No significant differences were observed between the earlier and later groups, with regard to 5- and 10-year survival rates.(ABSTRACT TRUNCATED AT 250 WORDS)

[The role of interleukin-2 in the impaired lymphocyte function after open heart surgery]

To reveal the mechanism of impaired lymphocyte function shown as the suppression of mitogenic proliferation of lymphocytes after open heart surgery, we evaluated the kinetics of Interleukin 2 (IL-2) production and response of lymphocytes sequentially until 7th day postoperatively in 10 patients. Membrane oxygenators were used exclusively and steroids were not administered during this study. In addition to the assay of mitogenic response (PHA), we measured IL-2 production and response utilizing IL-2 dependent cytotoxic T cell line and mitogenic proliferation to standard IL-2 respectively concomitant with plasma cortisol level. The results are as follows. 1. Mitogenic proliferation was suppressed with significance postoperatively (1POD: p less than 0.01). 2. IL-2 production was suppressed with significance postoperatively (3POD: p less than 0.05). In contrast no significant fluctuation of IL-2 responsiveness was observed postoperatively. 3. No correlation between plasma cortisol levels and these impairment was shown in this study. In conclusion impaired IL-2 production might be responsible for deficient lymphocyte function after open heart surgery.

Nephrectomy in renal carcinoma with distant metastasis

A total of 96 cases of renal carcinoma with distant metastasis at the time of diagnosis was studied. The patients were classified into 4 groups: Group O (16) in whom nephrectomy was not performed, Group A (51) who died due to carcinoma within 1 year of nephrectomy, Group B (25) who died due to carcinoma 1 to 3 years after nephrectomy, and Group C (4) who survived for 3 years or more after nephrectomy. Six clinical measurements were evaluated: haemoglobin, ESR, alpha 2 globulin, temperature, weight and C reactive protein. In addition, performance status, the number of organs with metastases, number of metastatic lesions and tumour growth rate were measured. The results showed that in patients surviving for 1 year or more after nephrectomy, there was an abnormality in the results of 3 or less of the 6 clinical measurements, performance was 0 or 1, and the carcinoma had metastasised to only one organ. In addition, it was found that the growth of metastatic lesions in patients who survived for 3 years or more was much slower than in the other patients. Nephrectomy was found to be effective in only 27% of our cases and we consider that careful deliberation should be made pre-operatively as to whether nephrectomy is really necessary in patients with metastasis. The decision should be made on the basis of the results obtained in the 6 clinical measurements given above.

The effect of cardiopulmonary bypass on T cells and their subpopulations

To investigate the effect of cardiopulmonary bypass (CPB) on T cells, lymphocyte subsets of peripheral blood and lymphoid organs were monitored during and after open-heart surgery (Group 1). As a control, lymphocyte subsets of peripheral blood were measured in patients undergoing thoracovascular operations without CPB (Group 2). In Group 1, analysis of each subset-to-total lymphocyte ratio revealed that observed lymphocytopenia in the early postoperative days was mainly the result of T cell reduction, and that the decrease of helper/inducer T cells contributed to this decrease. In contrast, no significant fluctuation of any lymphocyte subpopulation ratio was observed in Group 2. Analysis of lymphocyte subpopulation ratios in lymphoid organs showed that reciprocal changes of T cells and their subsets were observed in the bone marrow, thus indicating that the redistribution of T cells (especially of helper/inducer cells) seems to occur between peripheral blood and bone marrow in Group 1. Furthermore, there was no relationship between serum cortisol levels and the changes in lymphocyte subset ratios in Group 1 patients.

[Clinical observation of pheochromocytoma]

Eleven cases of pheochromocytoma observed at our department between 1976 and 1985 are presented. There were 5 males and 6 females and they were between 18 and 59 years old. The site of the tumor was in the right adrenal in 4 cases, left adrenal in 3 cases, bilateral adrenals in 2 cases and extra adrenal in 3 cases, 1 of which had multiple lesions and involvement of the right adrenal. Clinical symptoms observed were hypertension in 10 cases, headache in 7 cases, palpitation in 3 cases and nausea in 2 cases. Atypical adrenal pheochromocytoma was seen in 1 case. Definitive diagnosis was established by determination of urinary catecholamine levels in the 24-hour sample. Urinary levels of catecholamine revealed higher adrenaline levels for paroxysmal type and higher nor-adrenaline levels for extra-adrenal cases. For localization of tumors, computed tomography was most useful with a diagnostic rate of 100%, followed by ultrasonography and adrenal scan. As preoperative treatment, blood transfusion and administration of adrenergic blocking agents were performed in 9 cases. In all but 2 cases, hypertension was improved and no recurrence was seen after the operation.