Persistent magnetic coherence in magnets

When excited, the magnetization in a magnet precesses around the field in an anticlockwise manner on a timescale governed by viscous magnetization damping, after which any information carried by the initial actuation seems to be lost. This damping appears to be a fundamental bottleneck for the use of magnets in information processing. However, here we demonstrate the recall of the magnetization-precession phase after times that exceed the damping timescale by two orders of magnitude using dedicated two-colour microwave pump-probe experiments for a Y3Fe5O12 microstructured film. Time-resolved magnetization state tomography confirms the persistent magnetic coherence by revealing a double-exponential decay of magnetization correlation. We attribute persistent magnetic coherence to a feedback effect, that is, coherent coupling of the uniform precession with long-lived excitations at the minima of the spin-wave dispersion relation. Our finding liberates magnetic systems from the strong damping in nanostructures that has limited their use in coherent information storage and processing.

Clinicopathologic Features of Adult-onset Still's Disease Complicated by Severe Liver Injury

Adult-onset Still's disease (AOSD) is a systemic inflammatory disorder. Severe liver injury has rarely been reported, although liver enzyme elevation is a common complication of AOSD. We herein report four cases of relapsed AOSD with severe liver disorder by tapering or terminating corticosteroids. Liver specimens revealed robust infiltration of inflammatory cells throughout the lobule, especially cluster of differentiation (CD) 8-positive cells. Relapsed AOSD was refractory to corticosteroid reintroduction and required immunosuppressants. Severe liver injury with AOSD is pathologically characterized by extensive lobular infiltration of CD8-positive cells, and we should consider additive immunosuppressive agents on corticosteroids for treatment.

Acute kidney injury is an unfavorable prognostic factor in acute liver failure and is associated with tumor necrosis factor-alpha

Acute kidney injury (AKI) is a common complication of acute liver failure (ALF); but its pathogenesis is unknown. ALF was divided into 2 subgroups; ALF with hepatic coma, which corresponds to ALF in the US and Europe, and ALF without hepatic coma. AKI has been shown to worsen the prognosis of ALF patients with hepatic coma; however, its prognostic significance in ALF without hepatic coma remains unknown. A single-center retrospective study of 174 patients with ALF was performed. AKI was defined according to KDIGO criteria. AKI developed in 29 (66.0%) of 44 ALF patients with hepatic coma and 27 (38.5%) of 130 ALF patients without hepatic coma. Systemic inflammatory response syndrome (SIRS) was found to be significantly associated with AKI incidence in ALF patients (P < .001). Tumor necrosis factor-alpha (TNF-α) was found to be significantly associated with the presence and severity of AKI (P = .0039 and P = .0140, respectively). On multivariate analysis, TNF-α was an independent risk factor linked with AKI (P = .0103). Even in the absence of hepatic coma, the transplant-free survival rate of ALF was significantly associated with the presence and severity of AKI. Even when hepatic coma is absent, AKI complicated in ALF is strongly associated with TNF-α and worsens the transplant-free survival rate. Before the onset of hepatic coma, plasma exchange, or extracorporeal blood purification to remove inflammatory cytokines should be considered in ALF patients.

Spontaneous Regression of Metachronous Intra-Abdominal Desmoid Tumor in a Patient with Familial Adenomatous Polyposis

Desmoid tumors are clonal fibroblastic neoplasms that arise in soft tissues. Patients with familial adenomatous polyposis (FAP) can develop intra-abdominal desmoid tumors. However, metachronous appearance of intra-abdominal desmoid tumor is rare, and its clinical course is not well known. Here, we report a case of spontaneous regression of metachronous intra-abdominal desmoid tumor in a 36-year-old man with FAP. The patient was diagnosed with FAP and underwent laparoscopic total colorectomy. Intra-abdominal desmoid tumor appeared 2 years later and progressed despite treatment with tamoxifen and sulindac. He received four cycles of combinatory therapy with dacarbazine and adriamycin, resulting in shrinkage and stabilization of the desmoid tumor even after cessation of chemotherapy. A new intra-abdominal desmoid tumor developed 2 years later at a different site from the first lesion and progressed from 65 mm to 70 mm in diameter within a month. The size of the first lesion, however, remained unchanged. We prepared for chemotherapy because the second lesion progressed, but follow-up computed tomography showed spontaneous shrinkage of the second lesion. The patient still has not needed additional therapy as of more than 4 years after the appearance of the second lesion. Immunohistochemical staining showed the presence of macrophages in the second lesion. Although metachronous intra-abdominal desmoid tumor is rare and management protocols have yet to be established, this case suggests that an active surveillance approach may be applicable under careful follow-up in asymptomatic patients.

Factors Contributing to the Prognosis after Second-line Therapy with Ramucirumab in Advanced Hepatocellular Carcinoma

Objective Multiple therapeutic agents exist for advanced hepatocellular carcinoma (HCC), but prognostic factors in second-line and subsequent therapies are unclear. Ramucirumab is a molecular-targeted agent effective against hepatocytes with alpha-fetoprotein (AFP) >400 ng/mL after sorafenib failure. We examined the prognostic factors and efficacy of ramucirumab with prior therapy other than sorafenib. Methods In our retrospective multicenter study, 33 patients were treated with ramucirumab for HCC with prior therapy other than sorafenib, including 1 patient who received 2 lines of ramucirumab. We analyzed background factors, liver reserve, the prognosis, and treatment duration and efficacy. Results The median albumin-bilirubin (ALBI) value showed little change during ramucirumab treatment. The ALBI value improved in 32% of patients, and their prognoses were better than in those who did not improve. Response and efficacy rates were not as high as those in the REACH-2 study but were similar when limited to patients with 2,500 ng/mL AFP. Thirteen patients received further treatment after ramucirumab failure and they had a significantly better prognosis from ramucirumab administration and also had a significantly better prognosis from the start of the first tyrosine kinase inhibitor than who did not received further treatment. In univariate and multivariate analyses of prognostic factors, the continuation of treatment with another drug after ramucirumab failure and a good ALBI value at initiation were significant. The presence of a ramucirumab response and treatment duration were not associated with the prognosis. A good ALBI value at initiation and ALBI value improvement during treatment were also identified as independent factors associated with eligibility for further treatment after ramucirumab failure. The treatment line did not correlate with the availability of treatment with another drug after treatment failure. Conclusions ALBI value improvement with ramucirumab treatment allows for subsequent treatment after failure and an improved overall prognosis.

Theranostic SPECT reconstruction for improved resolution: application to radionuclide therapy dosimetry

Background

SPECT-derived dose estimates in tissues of diameter less than 3× system resolution are subject to significant losses due to the limited spatial resolution of the gamma camera. Incorporating resolution modelling (RM) into the SPECT reconstruction has been proposed as a possible solution; however, the images produced are prone to noise amplification and Gibbs artefacts. We propose a novel approach to SPECT reconstruction in a theranostic setting, which we term SPECTRE (single photon emission computed theranostic reconstruction); using a diagnostic PET image, with its superior resolution, to guide the SPECT reconstruction of the therapeutic equivalent. This report demonstrates a proof in principle of this approach.

Methods

We have employed the hybrid kernelised expectation maximisation (HKEM) algorithm implemented in STIR, with the aim of producing SPECT images with PET-equivalent resolution. We demonstrate its application in both a dual ⁶⁸Ga/¹⁷⁷Lu IEC phantom study and a clinical example using ⁶⁴Cu/⁶⁷Cu.

Results

SPECTRE is shown to produce images comparable in accuracy and recovery to PET with minimal introduction of artefacts and amplification of noise.

Conclusion

The SPECTRE approach to image reconstruction shows improved quantitative accuracy with a reduction in noise amplification. SPECTRE shows great promise as a method of improving SPECT radioactivity concentrations, directly leading to more accurate dosimetry estimates in small structures and target lesions. Further investigation and optimisation of the algorithm parameters is needed before this reconstruction method can be utilised in a clinical setting.

Room temperature and low-field resonant enhancement of spin Seebeck effect in partially compensated magnets

Resonant enhancement of spin Seebeck effect (SSE) due to phonons was recently discovered in Y[Formula: see text]Fe[Formula: see text]O[Formula: see text] (YIG). This effect is explained by hybridization between the magnon and phonon dispersions. However, this effect was observed at low temperatures and high magnetic fields, limiting the scope for applications. Here we report observation of phonon-resonant enhancement of SSE at room temperature and low magnetic field. We observe in Lu[Formula: see text]BiFe[Formula: see text]GaO[Formula: see text] an enhancement 700% greater than that in a YIG film and at very low magnetic fields around 10[Formula: see text] T, almost one order of magnitude lower than that of YIG. The result can be explained by the change in the magnon dispersion induced by magnetic compensation due to the presence of non-magnetic ion substitutions. Our study provides a way to tune the magnon response in a crystal by chemical doping, with potential applications for spintronic devices.

Fast Heating of Imploded Core with Counterbeam Configuration

A tailored-pulse-imploded core with a diameter of 70  μm is flashed by counterirradiating 110 fs, 7 TW laser pulses. Photon emission (>40  eV) from the core exceeds the emission from the imploded core by 6 times, even though the heating pulse energies are only one seventh of the implosion energy. The coupling efficiency from the heating laser to the core using counterirradiation is 14% from the enhancement of photon emission. Neutrons are also produced by counterpropagating fast deuterons accelerated by the photon pressure of the heating pulses. A collisional two-dimensional particle-in-cell simulation reveals that the collisionless two counterpropagating fast-electron currents induce mega-Gauss magnetic filaments in the center of the core due to the Weibel instability. The counterpropagating fast-electron currents are absolutely unstable and independent of the core density and resistivity. Fast electrons with energy below a few MeV are trapped by these filaments in the core region, inducing an additional coupling. This might lead to the observed bright photon emissions.

Direct heating of a laser-imploded core by ultraintense laser-driven ions

A novel direct core heating fusion process is introduced, in which a preimploded core is predominantly heated by energetic ions driven by LFEX, an extremely energetic ultrashort pulse laser. Consequently, we have observed the D(d,n)^{3}He-reacted neutrons (DD beam-fusion neutrons) with the yield of 5×10^{8} n/4π sr. Examination of the beam-fusion neutrons verified that the ions directly collide with the core plasma. While the hot electrons heat the whole core volume, the energetic ions deposit their energies locally in the core, forming hot spots for fuel ignition. As evidenced in the spectrum, the process simultaneously excited thermal neutrons with the yield of 6×10^{7} n/4π sr, raising the local core temperature from 0.8 to 1.8 keV. A one-dimensional hydrocode STAR 1D explains the shell implosion dynamics including the beam fusion and thermal fusion initiated by fast deuterons and carbon ions. A two-dimensional collisional particle-in-cell code predicts the core heating due to resistive processes driven by hot electrons, and also the generation of fast ions, which could be an additional heating source when they reach the core. Since the core density is limited to 2 g/cm^{3} in the current experiment, neither hot electrons nor fast ions can efficiently deposit their energy and the neutron yield remains low. In future work, we will achieve the higher core density (>10 g/cm^{3}); then hot electrons could contribute more to the core heating via drag heating. Together with hot electrons, the ion contribution to fast ignition is indispensable for realizing high-gain fusion. By virtue of its core heating and ignition, the proposed scheme can potentially achieve high gain fusion.

Fusion using fast heating of a compactly imploded CD core

A compact fast core heating experiment is described. A 4-J 0.4-ns output of a laser-diode-pumped high-repetition laser HAMA is divided into four beams, two of which counterilluminate double-deuterated polystyrene foils separated by 100  μm for implosion. The remaining two beams, compressed to 110 fs for fast heating, illuminate the same paths. Hot electrons produced by the heating pulses heat the imploded core, emitting x-ray radiations >20  eV and yielding some 10(3) thermal neutrons.

Real time reverse transcriptase polymerase chain reaction of urinary cytokeratin 20 detects transitional cell carcinoma cells

PURPOSE

We evaluate the diagnostic use of cytokeratin 20 messenger (m) RNA quantitation in urine as a marker of urothelial transitional cell carcinoma using the real time reverse transcriptase polymerase chain reaction (RT-PCR).

MATERIALS AND METHODS

Spontaneously voided urine was obtained from 47 patients with urothelial transitional cell carcinoma (carcinoma group), 19 other urological diseases (noncarcinoma group) and 27 healthy volunteers (control group). Quantification of cytokeratin 20 was performed with mRNA extracted from urine samples with primers and hybridization probes specific for cytokeratin 20 on a LightCycler instrument (Roche Diagnostics Corp., Indianapolis, Indiana).

RESULTS

This method allowed reproducible quantitation of 10 to 106 cytokeratin 20 expressing colon carcinoma cells per 107 peripheral blood leukocytes, comparable to the sensitivity of conventional RT-PCR with a wide linear measuring range. Cytokeratin 20 mRNA values in the carcinoma group (mean 35,850) were significantly higher than noncarcinoma (171) and control groups (4.55, p <0.0001 and <0.0001, respectively). Urinary cytokeratin 20 mRNA values significantly correlated with tumor grade, urinary cytological class, immunostaining pattern and depth of tumor invasion. Sensitivity and specificity of real time RT-PCR with a cutoff value of 15 were 81% and 83%, whereas those of conventional cytology were 28% and 100%, respectively.

CONCLUSIONS

These results indicate that real time cytokeratin 20 RT-PCR is a sensitive, quantitative, rapid and specific method to detect free cancer cells in the urine, with good potential for monitoring recurrence of urothelial transitional cell carcinoma.

An anterior urethral stitch improves urinary incontinence following radical prostatectomy

OBJECTIVE

To determine the effects of an anterior urethral stitch, referred to as an endopelvic anterior urethral stitch (EAUS), in reducing recovery time for post-prostatectomy urinary incontinence.

METHODS

The urinary continence recovery time for 24 patients, who received a retropubic radical prostatectomy with the EAUS procedure, was compared to that of a historical control series of 22 patients without EAUS. The EAUS is a simple 2-0 polyglactin stitch placed between the bunched dorsal vein complex and the anterior urethra. This procedure was performed at the time of urethro-vesical anastomosis. Continence recovery time was defined as the day after removal of the urethral catheter when the patient no longer required pads for incontinence.

RESULTS

A significantly shorter time for continence recovery (median 8.5 days) was obtained in EAUS patients compared with that of the control series (median 72 days) (P < 0.0001). Early recovery of continence was observed in 12/24 patients (50%) within 1 week and 18/24 patients (75%) within 1 month in EAUS patients. No adverse effects or complications were observed in the EAUS patients.

CONCLUSION

A surgical procedure, the EAUS, has been developed that reduces urinary incontinence in patients who have undergone a radical prostatectomy. This procedure is simple and quick and improves recovery of continence without any side-effects.

Aminopeptidase N regulated by zinc in human prostate participates in tumor cell invasion

Aminopeptidase N (AP-N) degrades collagen type IV and is proposed to play a role in tumor invasion. However, the precise functions of AP-N in tumor cells and the relationship of AP-N to prostate cancer remains unclear. In our study, we examined a possible role for zinc in the regulation of AP-N enzymatic activity in relation to tumor cell invasion in human prostate. AP-N purified from human prostate was irreversibly inhibited by low concentrations of zinc (Ki = 11.2 microM) and bestatin. AP-N, which has zinc in the active center, was also inhibited by the chelating agents, EDTA, o-phenanthroline and EGTA. EDTA was shown to remove zinc from the enzyme. When the effects of zinc and bestatin on invasion of PC-3 cells were investigated in vitro using a Transwell cell-culture chamber, zinc and bestatin effectively suppressed cell invasion into Matrigel at the concentration range of 50-100 microM. These results strongly suggest that the suppression of PC-3 cell invasion by zinc is based on the inhibition of AP-N activity by zinc. We also evaluated the expression of AP-N to investigate the relationship with the progression of prostate disease in human cancerous prostate. AP-N was found to be located at the cytoplasmic membranes of prostate gland epithelial cells and to be expressed more in prostate cancer, while the expression of prostate-specific antigen (PSA), which is a useful marker for prostate cancer, was shown in normal and cancer tissues, suggesting that AP-N is potentially a good histological marker of prostate cancer. Thus, highly expressed AP-N in human cancerous prostate probably plays an important role in the invasion and metastasis of prostate cancer cells.

[Kinetics of peripheral blood CD34-positive cells and the optimum timing for harvesting peripheral blood stem cells during BEP chemotherapy in patients with testicular germ cell tumor]

PURPOSE

Recently, high-dose chemotherapy with peripheral blood stem cell (PBSC) rescue has been developed for poor risk testicular germ cell cancer. In this study, we investigated the optimum timing for harvesting PBSCs with the use of bleomycin + etoposide + cisplatin (BEP) chemotherapy, which is a well known first-line regimen for the testicular cancer.

MATERIAL AND METHOD

Peripheral blood CD34-positive cell ratios were measured during a total of 10 courses of BEP chemotherapy in 6 patients with metastatic germ cell cancer between 1996 and 1998. We performed 4 apheresis in 3 patients during this period. Recombinant human granulocyte-colony stimulating factor (rhG-CSF) was administrated from the day on which the neutrophil count decreased less than 1,000/microliter.

RESULTS

The peripheral blood CD34-positive cell ratios became maximum (3.0-24.6%; average 10.0%) on the day 18 to 21 (median day 19) of BEP chemotherapy with rhG-CSF administration. The maximum ratios of peripheral blood CD34 positive cells were achieved when the number of leukocyte were 6,880-23,600/microliter and exceeded 6,000/microliter after the 18th day of BEP chemotherapy. The average number of collected CD34 positive cells was 9.5 x 10(6)/kg at a single apheresis, and 12.6 x 10(6)/kg per patient.

CONCLUSION

Efficient hematopoietic progenitor cells were mobilized by BEP chemotherapy with rhG-CSF administration of first-line setting. Our results suggest that the optimum timing of PBSCs harvest is the day when the numbers of leukocyte exceed 6,000/microliter after the 18th day of BEP chemotherapy and the following day.

Developmental changes in distribution of death-associated protein kinase mRNAs

Death-associated protein kinase (DAP-kinase) is Ca(2+)/calmodulin-dependent serine/threonine kinase that contains ankyrin repeats and the death domain. It has been isolated as a positive mediator of interferon-gamma-induced apoptotic cell death of HeLa cells. In order to reveal the physiological role of DAP-kinase, the tissue distribution and developmental changes in mRNA expression of DAP-kinase were investigated by Northern blot and in situ hybridization analyses. DAP-kinase mRNA was predominantly expressed in brain and lung. In brain, DAP-kinase mRNA had already appeared at embryonic day 13 (E13) and was, thereafter, detected throughout the entire embryonic period. High levels of expression were detected in proliferative and postmitotic regions within cerebral cortex, hippocampus, and cerebellar Purkinje cells. These findings suggest that DAP-kinase may play an important role in neurogenesis where a physiological type of cell death takes place. The overall expression of DAP-kinase mRNA in the brain gradually declined at postnatal stages, and the expression became restricted to hippocampus, in which different expression patterns were observed among rostral, central, and caudal coronal sections, suggesting that DAP-kinase may be implicated in some neuronal functions. Furthermore, it was found that the expression of DAP-kinase mRNA was increased prior to a certain cell death induced by transient forebrain ischemia, indicating a possible relationship between DAP-kinase and neuronal cell death.

[Detection of circulating cancer cells by nested reverse transcription-polymerase chain reaction of cytokeratin-19 in patients with renal cell carcinoma]

Detection of circulating cancer cells in peripheral blood may improve cancer staging and monitoring. This study was undertaken to investigate the clinical implications of detection of circulating cancer cells in renal cancer patients. Cytokeratin-19 (CK19) mRNA was amplified by nested reverse transcription-polymerase chain reaction (RT-PCR) in the peripheral blood of 33 healthy volunteers and 19 patients with renal cell carcinoma. The detection limit of the method was 10 cancer cells in 10(7) peripheral blood mononuclear cells. The positive detection rate was 47% for renal cancer patients and 9% for healthy volunteers. The number of patients expressing CK19 mRNA in each clinical stage was 0 out of 3 patients in stage 1; 2 out of 8 (25%) in stage 2; 3 out of 4 (75%) in stage 3; 4 out 4 (100%) in stage 4. A significant correlation was seen between CK19 mRNA expression and clinical stage (p = 0.0023). This method may be useful for early detection of micrometastasis, and facilitate the design of better therapeutic strategies for the treatment of renal cancer patients.

HNF-6 is expressed in endoderm derivatives and nervous system of the mouse embryo and participates to the cross-regulatory network of liver-enriched transcription factors

Hepatocyte nuclear factor-6 (HNF-6) is a liver-enriched transcription factor that contains a single cut domain and a novel type of homeodomain. Here we have studied the developmental expression pattern of HNF-6 in the mouse. In situ hybridization experiments showed that HNF-6 mRNA is detected in the liver at embryonic day (E) 9, at the onset of liver differentiation. HNF-6 mRNA disappeared transiently from the liver between E12.5 and E15. In transfection experiments HNF-6 stimulated the expression of HNF-4 and of HNF-3 beta, two transcription factors known to be involved in liver development and differentiation. HNF-6 was detected in the pancreas from E10.5 onward, where it was restricted to the exocrine cells. HNF-6 was also detected in the developing nervous system. Both the brain and the spinal cord started to express HNF-6 at E9-9.5 in postmitotic neuroblasts. Later on, HNF-6 was restricted to brain nuclei, to the retina, to the ventral horn of the spinal cord, and to dorsal root ganglia. Our observations that HNF-6 contributes to the control of the expression of transcription factors and is expressed at early stages of liver, pancreas, and neuronal differentiation suggest that HNF-6 regulates several developmental programs.

All-optical modulation with anomalous photovoltaic film on a Ti:LiNbO(3) waveguide modulator

An anomalous photovoltaic film formed by simultaneous oblique sputter deposition of CdTe and CdS from different directions was integrated onto LiNbO(3) and combined with a Mach-Zehnder-type interferometric waveguide modulator. Irradiation by 830-nm laser light with low intensity near 1 mW of the photovoltaic film induced anomalous photovoltages of ~5 V, which is as high as the half-wave voltage. This photovoltage was used to control the signal light in the waveguide. Modulation by external light was demonstrated with a response time of 0.1 s. Because of the presence of CdS with a photoconductive effect, the response time was much faster than that of conventional anomalous photovoltaic films formed by oblique deposition of CdTe.

Stereologically estimated mean nuclear volume of prostatic cancer is a reliable prognostic parameter

Although different histological grading systems of prostatic cancer refer to well-described characteristics, results are hard to reproduce. The aim of this study was to obtain morphometric data that would enable objective and reproducible grading of prostatic cancers by stereological estimation of mean nuclear volume (MNV). The clinical records and tissue specimens from 100 patients who were newly diagnosed as having prostatic cancer from 1973 to 1990 and who were followed up for 5 years or longer were retrospectively examined. We analysed the relationship between MNV and clinical stage, Gleason score and histological grading according to the World Health Organization (WHO) classification. To evaluate prognostic predictors, a multivariate analysis of factors associated with cause-specific survival was performed. We found a good correlation between the MNV and clinical stage and between the MNV and histological grading. There was no correlation between MNVs and Gleason scores. Multivariate analysis revealed that the MNV was the only predictor of survival time (coefficient 0.005; P < 0.0001; hazard ratio 1.005). We consider that the MNV is an excellent predictor of the prognosis in patients with prostatic cancer. Moreover, stereological estimation of MNV is a simple, quick, inexpensive and reliable morphometric procedure that enables the quantitative analysis of the histological and biological character of prostatic cancer.

[Effect of pamidronate and interferon-alpha on bone and lung metastases and hypercalcemia in a patient with renal cell carcinoma]

Pamidronate is a second generation bisphosphonate used for treating tumor-induced hypercalcemia and for preventing the development of new bone metastasis. A 47-year-old man with renal cell carcinoma was admitted in our institution because of hypercalcemia with multiple metastasis in bone, lung and lymph nodes. After embolization of the right renal artery, the patient was treated with pamidronate and interferon-alpha. Intravenous pamidronate significantly reduced bone pain and normalized the serum calcium level. The pulmonary metastasis responded to interferon therapy after 2 months of therapy. Radical nephrectomy was then carried out. Paraaortic lymph nodes were found to be necrosed completely. Ossification of osteolytic lesions was observed after two months of therapy and metastatic lesions in the lung showed complete remission (CR) after six months of therapy.

[Influence of extracorporeal shock wave lithotripsy (ESWL) on renal function assessed by 99mTc-DMSA scintigraphy: comparative analysis between ESWL and percutaneous nephroureterolithotripsy (PNL)]

99mTc-DMSA renal scintigraphy was utilized to investigate the influence of ESWL on renal function in comparison with that of PNL. In the beginning, the reproducibility of renal uptake rate by the scintigraphy was examined in eleven healthy volunteers under both non-diuretic and diuretic states. The renal uptake rate was shown to be sufficiently reproducible in the same person in the two different trials. However, the differences and the standard deviations were shown to be a few percentages, which were not statistically significant. Changes in the repeated renal uptake rate seem to indicate not only changes of renal function with the treatment but also some technical errors. Herein, to investigate changes in renal function of the therapeutic side, the uptake ratio rate (rate of uptake rate in the therapeutic side/uptake rate in the contral lateral side) was utilized instead of uptake rate. Renal scintigraphy was carried out in 48 patients with unilateral renal stones before and after ESWL or PNL monotherapy or the combined ESWL and PNL therapies. Within one week of treatment, the uptake ratio rate significantly decreased in patients with PNL or the combined ESWL and PNL, although DMSA uptake rate in the therapeutic side did not significantly changes. Neither renal uptake rate nor uptake ratio rate significantly changed after ESWL treatment. There was no significant difference in changes of uptake ratio rate between Siemens Lithostars Plus and the improved Dornier HM-3 lithotriptors. This study indicated that ESWL monotherapy did not affect the uptake ratio rate, although PNL monotherapy and the combined ESWL and PNL therapies may affect the uptake ratio rate to some extent.

[Mass screening for prostate cancer at a local town--five-year results and screening system]

The results of a mass screening examination for prostate cancer conducted from 1989 to 1993 at a local town, Kawagoe-cho, in Mie Prefecture were evaluated. Among the 216 examinees, 4 were found to have prostate cancer. The most accurate examination was the prostate specific antigen (PSA), which was followed by digital examination and transrectal ultrasound. The applicants for the prostate cancer screening accounted for only 8% of the Kawagoe-cho male residents over 40 years old. An educational campaign of prostate disease in the area must be started to increase the number of applicants. We concluded that the most effective modality for the screening program was a combination of PSA and digital examination in the field study, and transrectal ultrasound accompanied by systemic biopsy results in the second tool for screening.

[Local recurrence of ureteral tumor histologically similar to malignant lymphoma: a case report]

A 65-year old man, who had had resection of a right ureter tumor two years earlier, was hospitalized with complaints of lower abdominal discomfort and hematuria. Pathological diagnosis of the ureteral tumor was grade 3 transitional cell carcinoma. Computed tomography and magnetic resonance imaging demonstrated a large tumor in the retrovesical space and recurrence of transitional cell carcinoma was suggested. Total pelvic exenteration was performed and pathological diagnosis of the tumor was undifferentiated carcinoma simulating malignant lymphoma. Immunohistochemical examinations revealed no antigens specific for the lymphoid cells or epithelial cells on the specimen. This tumor consisting of undifferentiated carcinoma was considered to be recurrence of transitional cell carcinoma with the diffuse pattern simulating malignant lymphoma proposed by Zukerberg et al.

[Dietary control for out-patients in urinary stone clinic]

We studied the dietary habits of 113 upper urinary tract stone formers and 24-h urine specimens before and after dietary control. Protein intake was decreased in male patients after dietary control but urinary risk factors were not changed significantly. The excretion of urinary risk factors (calcium, uric acid and oxalate) was decreased in the patients who had calcium excretion of more than 250 mg per day or uric acid excretion more than 650 mg per day or oxalate excretion more than 45 mg per day before the control. The daily protein intake was significantly correlated to urinary uric acid, calcium, and phosphate excretion and the daily vitamin C intake to urinary citrate excretion. There was a negative correlation between the daily calcium intake and urinary oxalate. The mean stone episode rate of these patients was significantly decreased from 0.174 to 0.059 stones per year by dietary control (p < 0.005).

[Phase II clinical study of 99mTc-MAG3]

Phase II clinical study of mercaptoacetylglycyl-glycylglycinate (99mTc) technetium (99mTc-MAG3), a new scintigraphic and renographic agent, was performed to evaluate its safety, clinical usefulness and optimal dosage at 5 institutions in total 88 patients with mild renal or urinary disorders. There was no case showed adverse reaction in patients studied and the administration of the agent was proved to be safe. The effectiveness of the agent was evaluated and revealed to be effective in all cases analyzed. A range of dosage 200-400 MBq was found to be optimal, from image quality and clinical information obtained. It is concluded that 99mTc-MAG3 is a safe and useful radiopharmaceutical for the diagnosis of renal dynamic function.

[Repair of skin defect after extensive resection for penile cancer: report of two cases, and clinical observation of patients with penile cancer at Mie University hospital]

Case 1: A 48-year-old male with stage 4 penile cancer is reported. We used peplomycin (PEP) and cisplatinum (CDDP) for preoperative chemotherapy. Chemotherapy was effective. Radical surgery with bilateral inguinal lymphadenectomy was done and skin defect was covered with a skin flap. Case 2: A 61-year-old male with stage 4 penile cancer underwent radical surgery after modified MBD therapy with methotrexate (MTX), PEP and CDDP. Emasculation with skin resection and inguinal and pelvic lymphadenectomy were performed. The skin defect was deep and wide. It was covered with a glacilis myocutaneous skin flap. Distal end of the flap became necrotic. It was covered with tensor fascia lata myocutaneous flap. Seventeen patients with penile cancer were treated between 1972 and 1990 at Mie University Hospital. Nine patients were in stage 1, 4 stage 2, 1 stage 3, 3 stage 4. Treatment consisted of surgery (3), surgery+chemotherapy (10), surgery+chemotherapy+irradiation (2), chemotherapy+irradiation (1), and surgery+irradiation(1). Cancer death was observed in 2 cases (stage 2), 2 patients died of other diseases, 10 are alive, and 3 patients were lost to follow up.

[A clinical study on renal cell carcinoma]

A retrospective study was carried out on 95 patients affected with renal cell carcinoma (RCC) between January 1973 and December 1988. Male to female ratio was 3 to 1 and the average age was 61 years. Hematuria was the most common initial symptom (44 patients, 46.3%), followed by incidental findings (18 patients, 18.9%). Five- and 10-year survival rates for all patients with RCC were 51.9 and 37.1%, respectively. Five-year survival rates for stage I, II, III, and IV were 82.7 54.7, 20.0, and 4.7%, respectively. Statistical analyses identified variables that significantly influenced survival, including lymph node metastasis (p less than 0.01) and distant metastasis (p less than 0.01). Cell type and renal vein involvement did not influence survival significantly. The three different forms of therapy (mitomycin therapy vincristine therapy and immunological therapy) did not influence survival significantly, but the beneficial effect of VBL therapy was obtained.

[A clinical investigation on renal pelvic and ureteral tumors]

The 60 cases of primary renal pelvic and ureteral tumors treated at Mie University hospitals between January 1977 and December 1987 were reviewed and factors predicting the prognosis were investigated. The patients consisted of 47 men and 13 women (3.6: 1.0). Their ages ranged from 38 to 82 years with a mean of 65.2 years. According to Akaza's category classification of the ureteropelvic tumor, 42 cases were classified to category A, 15 cases category B and 1 case was classified to category C. Histologically, 59 transitional cell carcinomas and 1 squamous cell carcinoma were found. As to grading, 5 was G1, 31 G2, 21 G3 and 2 GX. As to staging, 20 were pT1, 10 pT2, 21 pT3, 3 pT4 and 6 pTX. Staging was correlated well with grading. Total nephroureterectomy with bladder cuff was performed on 39 patients and the other surgical treatments were done on 15 patients. Recurrence of the bladder tumor was found in 22.4%. The 5-year survival rate (Kaplan-Meier's method) was 47.8% for all of the patients. Among the patients with transitional cell carcinoma, the 5-year survival rate was 100% for G1, 57.6% for G2 and 28.6% for G3. As to staging the 5-year survival rate was 90.0% for below pT1, 20.0% for pT2 and 41.1% for pT3. The results from the present study suggest the prognosis is decided by grade and stage in pelvic and ureteral tumors, and it is wanted to develop a system of postoperative adjuvant therapy.

[Correlation between histologic grading and prognosis of prostatic cancer--comparing the grading system of the Japanese general rules of prostatic cancer with Gleason's grading]

To evaluate the correlation between the histological grade and the prognosis, we reviewed 100 cases of prostatic cancer according to the Japanese General Rules of Prostatic Cancer (JGRPC) and Gleason grading system. The study led to the following results: (1) There was a close relation between the JGRPC grade and Gleason score (GS). (2) The JGRPC grade and Gleason score were equally concerned with the clinical stage. (3) There were significant differences in survival rate between well and moderately, well and poorly differentiated groups by the JGRPC grading system, and between GS 2-4 and GS 5-7, GS 2-4 and GS 8-10 groups by Gleason score. (4) In proportion to the JGRPC grade, the cancer death rate increased linearly in each stage. (5) When the patients were grouped according to their JGRPC grades of main lesion and accompanied lesion, the cancer death rate increased in the cases with lower differentiated elements. We conclude that the JGRPC grading system is easily comprehensible, and equal with the Gleason grading system to predict the prognosis of prostatic cancer.

[A case of renal cell carcinoma and bladder carcinoma associated with von Hippel-Lindau disease]

A case of renal cell carcinoma and bladder carcinoma associated with von Hippel-Lindau disease is reported. A 31-year-old female was referred to the Department of Urology for further examination of right renal mass which was incidentally found on abdominal computed tomography (CT). The patient was operated on spinal hemangioma in May 19 and July 8, 1975, on cerebellar hemangioblastoma in July, 1976 and June 10, 1981 and on cerebellar cyst in June 20, 1988. Angiography revealed three hypervascular renal tumors in the right kidney. Cystoscopy revealed a papillary bladder tumor (TCC Grade 1). Transurethral resection of bladder carcinoma was performed on July 28, 1988. Right radical nephrectomy and lymphadenectomy were performed on August 2, 1988. Histopathologically, the tumor was renal cell carcinoma of clear cell type (Grade 1). Postoperative course was uneventful and the residual kidney is being followed up in the outpatient clinic.

[Clinical study of intravesical instillation therapy of superficial bladder tumor--combination therapy of mitomycin C, adriamycin, peplomycin and cytosine arabinoside]

The effect of intravesical combination chemotherapy on superficial bladder tumors was analyzed. Seventy-two patients were treated with intravesical instillation of the following anticancer drugs. MMC group: Mitomycin C (MMC) 10 mg and cytosine arabinoside (CA) 300 mg. ADM group: Adriamycin (ADM) 30 mg and CA 300 mg. PEP group: Peplomycin (PEP) 30 mg and CA 300 mg. MAC group: MMC 10 mg, ADM 30 mg and CA 300 mg. Antitumor effects in the MMC, ADM, PEP and MAC groups were evaluated in 16, 18, 17 and 21 patients and objective response (CR + PR) of tumor was observed in 87.5%, 50.0%, 35.3% and 28.6% of these patients. The papillary tumors, small tumors and low grade tumors responded better to these intravesical chemotherapies than the non-papillary tumors, the middle grade tumors and the high grade tumors. The recurrence rate in 72 patients was 6.9, 14.6 and 26.8% within 1, 2 and 3 years. No significant difference in the recurrence rate was observed between the MMC, ADM, PEP and MAC group, but the MMC group tended to have a lower recurrence rate than the other groups. The recurrence rate for the low grade tumors and the middle grade tumors was significantly lower than that for the high grade tumors and the small tumors. The major side effect of instillation therapy with these drugs was bladder irritation which appeared in 16.7% of all the patients (78 cases). In conclusion, intravesical chemotherapy is a useful approach for controlling superficial urinary bladder tumors, especially the combination of MMC and CA.

[Renal function study assessed by 99mTc-DMSA renal scintigraphy before and after PNL]

99mTc-DMSA renal scintigraphy was carried out in 54 patients with unilateral renal stones before and after PNL. Four to 8 weeks after PNL the DMSA renal uptake significantly decreased to 17.2 +/- 6.0% from 18.2 +/- 6.7% before PNL. DMSA renal uptake did not change in the contralateral side. Since in some patients changes in the DMSA renal uptake of 5-7% were observed after PNL not only in the PNL side but also in the contralateral side, the renal function was assessed by the formula: DMSA renal uptake in the PNL side/DMSA renal uptake in the contralateral side, and the change of this ratio was evaluated in 44 patients, in whom the renal DMSA uptake in the PNL side was less than two times that in the contralateral side. The DMSA renal uptake ratio decreased to 95.6 +/- 8.7% from the base line 4-8 weeks after PNL. This change was statistically significant. Some functional risks such as massive bleeding with PNL, the fever after PNL and the number of nephrostomy tract did not affect the decrease in the renal function. In 29 patients in whom renal function was reevaluated one year after PNL, the DMSA renal uptake ratio significantly decreased to 94.2 +/- 9.6% from the base line 4-8 weeks after PNL. But the ratio significantly improved to 99.6 +/- 11.6% about one year after PNL. In two patients with a cold area on the renal image, the renal function of the operated side still remained at about 80% levels from the base line even one year after PNL.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case report of adult Wilms' tumor]

A 49-year-old women who presented with right upper abdominal mass and back pain had a nephroblastoma, Wilms' tumor, in the right kidney. After radical nephrectomy the patient was treated with chemotherapy in the form of actinomycin D and vincristine. Despite the intensive chemotherapy, the patient died of respiratory failure by multiple metastasis at chest wall and lung. The pathology and treatment of adult Wilms' tumor were discussed.

[A case of bilateral testicular germ cell tumor]

A case of bilateral successive tumor of germ cell origin is reported. A 29-year-old man visited our clinic with a complaint of swelling of right scrotal contents 18 months after initial left orchiectomy for a seminoma. The right orchiectomy was performed and its histological finding was also seminoma. Between 1965-1987 we treated 55 patients with testicular germ cell tumors. Two of them suffered a second germ cell tumor. One of them who had different histology of teratocarcinoma on left side and seminoma on right side had been reported previously. Herein, we report the second case and review the literature.

[Influences of endotoxin on oxidation of fatty acid in rabbits: a comparison between medium chain- and long chain-fatty acids]

Medium chain triglyceride emulsion (MCT) which is composed of 10% emulsion of tricaprylin (C8) or long chain triglyceride emulsion (LCT, 10% Intralipos) was infused intravenously to 20 rabbits for a period of 180 min (n = 10; MCT, n = 10; LCT). Five rabbits of each group were also given lipopolysaccharide (LPS B, E. Coli 055: B5, Difco Laboratories, Detroit Michigan, U.S.A.) at a rate of 0.3mg/kg/hr to a total dose of 0.9 mg/kg. The production of ketone-bodies (acetoacetate and beta-hydroxybutyrate) was quantified. MCT was more easily oxidized than LCT, regardless of the administration of LPS. Oxidation of LCT was suppressed by the administration of LPS, while that of MCT was not suppressed. In the presence of LPS, MCT caused a more pronounced decrease in the arterial ketone body ratio (acetoacetate/beta-hydroxybutyrate) than LCT. These results indicate that MCT seems to be a better energy source than LCT under the condition where the transport of fatty acid across the mitochondrial membrane was impaired by the administration of LPS.

[Clinical studies on ceftriaxone in complicated urinary tract infections]

Ceftriaxone (CTRX) was clinically evaluated in 20 cases of complicated urinary tract infections. CTRX was administered for 5 days at the dose of either 1 g or 2 g once a day by intravenous injection into 10 cases. The clinical efficacy was excellent in 8 cases, moderate in 9 and poor in 3 to make an overall clinical efficacy was 91% in 11 cases with catheter indwelt. Bacteriologically, 18 out of 21 causative pathogens disappeared with an eradication rate of 86%. Neither subjective nor objective adverse reactions were observed in any case. CTRX administration once a day is effective for complicated urinary tract infections.

[Clinical evaluation of gamma-seminoprotein as a serum marker of prostate carcinoma]

The serum levels of gamma-Seminoprotein (gamma-Sm) were determined by enzyme immunoassay in 77 patients with prostatic cancer (30 untreated and 47 treated), 44 patients with benign prostatic hypertrophy and 12 patients with prostatitis. Serum levels of gamma-Sm in each disease were as follows; untreated prostatic cancer 23.2 +/- 18.3 ng/ml (positive rate 93%), treated prostatic cancer 4.7 +/- 8.3 (positive rate 25.5%), benign prostatic hypertrophy 3.6 +/- 3.3 (positive rate 23.7%), prostatitis 2.0 +/- 2.0 (positive rate 7.7%). Serum gamma-Sm levels in prostatic cancer were higher in advanced stage but relatively low in poorly differentiated adenocarcinoma. We consider that the level of serum gamma-Sm is a useful tumor marker as well as prostatic acid phosphatase (PAP) in diagnosis and follow-up of the patients with prostatic cancer.

[Primary carcinoma of the male urethra: report of two cases]

Two cases of primary carcinoma of male urethra are reported. Case 1: A 31-year-old male, who complained of urethral bleeding, was admitted to our clinic in April, 1982. A rice size papillary tumor was found at the fossa navicularis in the glans, and resected by electric knife. Histologically, the tumor was well differentiated squamous cell carcinoma. Case 2: A 37-year-old man, who complained of urethral bleeding, was admitted to our clinic in July, 1985. A tumor was found at the fossa navicularis in the glans and resected. Histologically, the tumor was well differentiated squamous cell carcinoma confined to mucosa. These two cases have not shown any signs of recurrence. Including these cases, 135 cases of primary carcinoma of urethra in the literature in Japan are reviewed.

Influences of an infusion of lipid emulsion on phagocytotic activity of cultured Kupffer's cells in septic rats

An experimental study was undertaken to study the influences of an infusion of lipid emulsion on phagocytosis of Kupffer's cells in septic rats. Sepsis was induced in 13 rats by ligating the cecum. Five of them received glucose as the sole nonprotein calorie (septic-glucose group), four of the rats received 25% of the nonprotein calorie with lipid emulsion, Intralipid (septic-lipid group), and the remaining four rats did not receive any intravenous solution and were allowed access to water (septic-fasted group). Another four rats which received neither intravenous solution nor ligation of the cecum served as the control group. The intravenous infusion was carried out for 72 hr. The phagocytotic activity of Kupffer's cells was determined by the ability to engulf latex particles with a size of 1.09 micron, in vitro. The phagocytotic activity was enhanced by the presence of sepsis but it was inhibited by starvation. The difference in the phagocytotic activity between the septic-glucose group and the septic-lipid group was not significant. These results suggest that, insofar as an in vitro study is concerned, a 72-hr infusion of lipid emulsion at a rate of 25% of the total nonprotein calorie does not influence the phagocytotic activity of cultured Kupffer's cell obtained from septic rats.

Effects of total parenteral nutrition on the development of intestinal endotoxemia in rats: a comparison between glucose and lipid

The effects of parenteral nutrition (PN) and of the difference in the PN regimens between glucose and lipid emulsion on the development of endogenous endotoxemia were studied in 40 Wister rats. Endotoxemia was induced by occluding the superior mesenteric vein (SMV) for 30 min. The plasma endotoxin in the portal blood at the time of the release of the SMV occlusion and that in the arterial blood 10 min after the release were quantified. Twenty of the 40 rats had received PN for 48 hr prior to the SMV occlusion. Ten of these 20 rats received the total nonprotein calorie (TNPC) solely with glucose, and the other 10 rats received 25% of the TNPC with lipid emulsion. Ten rats had been allowed free access to lab food until the SMV occlusion. The remaining 10 rats underwent neither the SMV occlusion nor PN, and served as the control group. Both the portal and the arterial endotoxin increased after the release of the SMV occlusion, however the portal endotoxin was higher than that of the arterial one. Both the portal and the arterial endotoxin of the rats supported by PN were significantly lower than those of the rats nourished by lab food, while they were higher than the control values. The difference in the PN regimens did not cause any alteration in the endotoxin levels. These results indicate that the development of intestinal endotoxemia was not influenced by the difference in the PN regimens, but it was rather influenced by a presence of intestinal content.