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An aortic aneurysm was incidentally diagnosed in a 75-year-old woman during a thorough examination for other diseases. She had a history of total arch replacement( TAR) for aortic arch aneurysm 17 years previously. Contrast-enhanced computed tomography( CT) revealed a proximal aortic aneurysm with a maximum diameter of 67 mm protruding to the lateral side. She was treated by elective ascending aortic replacement. The resected aneurysm was not a pseudoaneurysm, but a true aneurysm. The etiology of this aneurysm might be long-term hemodynamic stress from the left ventricle and inadequate blood pressure control in addition to the anatomical position of the proximal residual aorta after first surgery. Therefore, to prevent aneurysm formation, it is important to replace the ascending aorta as proximally as possible at first surgery and to continue strict postoperative blood pressure control.

An excessive oxidative stress is considered to be responsible for the development and progression of heart disease. Deficiency of trace elements with antioxidative activities is present in patients with heart disease. Selenium (Se) is an integral part of the enzyme glutathione peroxidase(GPx), one of the central players of the heart's antioxidant system, and it's deficiency is implicated in certain types of heart disease. Our study suggests that myocardial oxidative stress in chronic heart failure may be augmented at least in part by concomitant GPx deficiency, and that the administration of Se could rescue the exhaustion of this selenoprotein, resulting in improved left ventricular function.

The patient was a 68-year-old man who had undergone sigmoidectomy 1 year previously. Adjuvant therapy with tegafur- uraci(l UFT) and Leucovorin( UZEL) was administered. Seven months later, the carcinoembryonic antigen( CEA) level increased to 7.5 ng/mL. Enhanced computed tomography (CT) revealed a 4-cm mass in the mesorectum, and the patient was diagnosed as having local recurrence. Chemotherapy with oxaliplatin, 5-fluorouracil, and Leucovorin( mFOLFOX6) and radiation therapy( 60 Gy) were administered. As the tumor could not be detected after chemoradiotherapy, abdominoperineal resection was performed. Pathological examination showed no cancer and indicated a complete response. The patients CEA level has not increased and no recurrence has been detected on enhanced CT for 3.5 years. The tumor could be decreased in size by chemoradiotherapy and the operation could be safely performed without resecting other organs. Although surgery is generally performed for local recurrence, multidisciplinary therapy could be useful in performing such surgery safely.

Objectives: Influenza A viruses play the largest role in the worldwide epidemiology of infectious diseases. We examined the effects of intact type and F(ab')2 type of immunoglobulin preparations on murine influenza A virus myocarditis in mice., Methods and Results: In vitro study showed that intact type and F(ab')2 type of immunoglobulin preparations had antiviral activities against many substrains of influenza A virus and other cardiotropic viruses, and that dose-dependent suppression of an influenza A virus (NWS type) was demonstrated by the treatment of both intact immunoglobulin and F(ab')2 fragments of immunoglobulin. The dose inhibiting 50% of plaques was same between intact type and F(ab')2 type (both 0.0002 mg/dl). Intact immunoglobulin, but not F(ab')2 fragments of immunoglobulin, suppressed serum macrophage inflammatory protein-2 (MIP-2) production in influenza A virus infected macrophages in vitro, which is a murine counterpart of interleukin-8. This suppression of MIP-2 production by intact immunoglobulin treatment was blocked by a specific Fc receptor (Fc gamma III/II receptor) antibody pretreatment. Intact immunoglobulin (1 g/kg/day) or F(ab')2 fragments of immunoglobulin (1 g/kg/day) were administered to the virus-inoculated A/J mice intraperitoneally daily, starting simultaneously with virus inoculation (Experiment I ) and 2 days after the virus inoculation (Experiment II ), until 10th days after virus inoculation. In Experiment I, survival was higher in treated [intact (100%, 20/20), and F(ab')2 (100%, 20/20)] than in control (25%, 5/20) mice; intact type and F(ab')2 type immunoglobulin administration completely suppressed the development of myocarditis. In Experiment II, survival rate was significantly higher (75%, 15/20) and myocarditis was less severe in intact immunoglobulin treated mice, but not in F(ab')2 fragment treated mice (60%, 12/20), than in untreated mice (35%, 7/20). Serum neutralizing antibody titers in treated mice were significantly higher compared with untreated mice in Experiments I and II. In addition, serum MIP-2 concentrations in intact immunoglobulin treated mice, but not in F(ab')2 fragments treated mice, were lower compared with untreated mice in Experiment II. Immunoglobulin therapy suppresses influenza A virus myocarditis by increasing neutralizing antibody titers and the suppression of myocardial virus activities. From the stand-point of suppression of MIP-2 concentrations, intact type is superior to F(ab')2 type., Conclusions: Immunoglobulin treatment may be promising for the prevention of influenza A virus myocarditis.

In the surgery of gastric cancer, it is necessary to consider not only the curability of gastric resection but also the quality of life of the patients in the choice of reconstruction method after distal gastrectomy. We have devised the jejunal pouch double tract method after gastrectomy. We reported in this study on the details of method and the satisfactory results. We employed 15 cases of gastric cancer which should be resected over three quarters of the stomach because the tumor occupation were in the middle third of the stomach and were expected long survival period. The operative procedure was as follows: (1) completion of gastric resection and lymph node dissection, (2) separation of jejunum at the site of 25 cm anal side from the Treitz's ligament, (3) pulling up the anal side of the jejunum preparing double jejunal pouch with approximately 10 cm in length using GIA, (4) anastomosis between residual stomach and jejunal pouch, (5) duodenojejunostomy at the site of 3-5 cm anal side from the pouch, (6) jejunojejunostomy at the site of 15 cm anal side from the duodenojejunostomy. Double tract reconstruction with jejunal pouch after distal gastrectomy is well-balanced method in the storage and discharging capacity, and useful in the view of better quality of life, especially in the cases which could be expected long survival period.

The predictive value of transesophageal echocardiography was investigated for the risk stratification of atherothrombotic or embolic cerebral infarction in patients with atrial fibrillation. Left atrial spontaneous echo contrast, peak flow velocity in the left atrial appendage and generalized atherosclerosis as estimated by the intima-media wall thickness of the thoracic aorta were assessed by transesophageal echocardiography in consecutive patients with paroxysmal (n = 25) or chronic (n = 60) atrial fibrillation (mean [+/-SD] age; 63 +/- 11 years). All patients underwent brain computed tomography or magnetic resonance imaging to evaluate the presence or absence of cerebral infarction. The location of cerebral infarction was divided into two territories, the cortical branch (cortical infarction) and deep perforators (perforating infarction), to evaluate embolic and atherothrombotic cerebral infarction, respectively. Cortical and perforating infarctions were found in 42% and 16% of all patients, respectively. The grade of spontaneous echo contrast was higher in patients with cortical infarction than in those without cortical infarction. Patients with perforating infarction showed thicker aortic wall compared with patients without perforating infarction. Other parameters had no predictive value to differentiate perforating from cortical infarctions. Multiple regression analysis revealed that spontaneous echo contrast and age were independent predictors of embolic cortical infarction, whereas intima-media wall thickness of the aorta and hypertension were useful in predicting the risk of atherothrombotic perforating infarction. Transesophageal echocardiography is useful for predicting embolic cortical infarction and atherothrombotic perforating infarction.

In order to study spatial arrangement and dynamics of chromosomes and nuclear structures, we have developed a computerized fluorescence microscope workstation. This microscope workstation is capable of rapidly acquiring three-dimensional, multiple-wavelength image data and allows accurate reconstructions of three-dimensional cellular structures stained with multiple fluorescent dyes. Using this microscope system, we have examined dynamics of chromosomes and microtubules in mammalian culture cells by combination of high-resolution analysis in fixed specimens and time-lapse analysis in living cells. A key aspect of such microscopic approaches is a capability of detecting transient events during dynamic biological processes.

The conventional method of transurethral resection of the prostate (TUR-P) is often not beneficial for small benign prostatic hyperplasia (BPH) because of a high frequency of postoperative bladder neck contracture (BNC). Herein, we examined the usefulness of semi-radical transurethral resection of the prostate (semi-radical TUR-P) from the view points of improvement of peak flow rate, the frequency of postoperative BNC and incidental carcinoma of the prostate in 79 cases of small BPH (group A) and 101 cases (group B) of large BPH in which less than 10 g for more than 10 g of the internal glands was resected, respectively. The bladder neck was resected carefully to avoid over resection which may cause BNC in small BPH cases. Satisfactory results were obtained in both groups, that is, the improvement of the peak flow rate from 7.03 +/- 3.79 ml/sec to 13.9 +/- 7.32ml/sec and from 4.96 +/- 2.88 ml/sec to 15.2 +/- 8.30 ml/sec, and the frequency of BNC were 2.53% (2/79) and 1.98% (2/101) in groups A and B, respectively. The frequency of incidental carcinoma of the prostate were 15.2% (12/79) and 17.8% (18/101) in groups A and B. We conclude that semi-radical TUR-P is a favorable maneuver for small BPH because of satisfactory improvement in peak flow rate with low frequency of postoperative BNC and its superiority in screening test for incidental carcinoma of the prostate.

We performed Raz procedure and Gittes procedure for female stress incontinence since October 1986. Raz procedure was performed on 19 patients between October 1986 and February 1990, and Gittes procedure was performed on 18 patients between June 1990 and May 1991. We followed up 17 patients who underwent Raz procedure and all the patients who underwent Gittes procedure at the time August 1991. Disappearance or marked improvement of incontinence was confirmed in 12 patients by Raz procedure, and 16 patients by Gittes Procedure. No serious complications were recognized. The reason why the result of Raz procedure was not sufficient was due to our immature operative technique and incorrect patient selection in our early experience. From this experience, we believe that both procedures can be very useful and minimal invasive operation for female stress incontinence.

Recently, the continent urinary reservoir which provides the patient with a better quality of life has become popular. Many types of reservoirs have been reported, but the optimal procedure remains to be established. From July 1987 through November 1988, we performed Kock pouch construction on 11 patients (ages 39 to 76 years). Between July 1989 and March 1991, 9 patients (ages 44 to 66 years) underwent Indiana pouch operation. The first 4 patients underwent ileal patch type, and the subsequent 5 underwent Heineke-Mikulicz type procedure. A one-stage radical cystectomy and continent urinary reservoir construction was performed on 19 patients, and bilateral cutaneous ureterostomy was converted to Kock pouch in one patient. There were no perioperative deaths, but reoperation was required for urinary leakage from the reservoir on one patient in each group. As the late complications in the Kock pouch group, one patient required revisional operation of the continent valve mechanism, 2 patients experienced intermittent prolapse of the nipple valve of the efferent limb, and 2 had malfunction of the afferent nipple valve. In the Indiana pouch group unilateral hydronephrosis was noticed in one patient, and 4 had mild difficulty of catheterization. Although 3 patients in both groups had mild urinary leakage, all patients had good quality of life with capacity of reservoir over 500 ml and with good renal function. We changed the type of operative procedure from Kock pouch to Indiana pouch because of the high complication ratio in the former.(ABSTRACT TRUNCATED AT 250 WORDS)

A 71-year-old female was seen initially with the complaint of gross hematuria. Cystoscopic examination revealed non-papillary tumor at the dome of the bladder and a transurethral biopsy showed signet ring cell carcinoma. En bloc segmental resection was performed, and the patient has been well without any evidence of progression. We report a case, which we believe to be the 6th in Japan, of signet ring cell carcinoma of the urachus.

The level of serum TPA was determined by radio-immunoassay in 19 healthy subjects and 90 patients with urogenital cancer. The normal level of serum TPA was 86 +/- 24 U/l, and the level of more than 134 U/l was determined positive. The positive rate of TPA was 38.9% in 90 patients, while that of CEA was 25.6%. In 19 patients with bladder tumor and 7 with testicular tumor, the positive rates of TPA were 52.6% and 71.4%, respectively, and the level of serum TPA was high in these positive patients. Considering the low positive rate of CEA, TPA may be a more useful marker than CEA in patients with bladder tumor and testicular tumor. Serial determinations of serum TPA and CEA showed the considerable variation of serum TPA compared with serum CEA and a temporary elevation of serum TPA following radical nephrectomy and retroperitoneal lymphadenectomy. However, the level of serum TPA fell significantly after the successful treatment in 8 patients (2 with renal cell cancer, 3 with bladder tumor, 1 with prostate cancer, 2 with testicular tumor) and rose sharply with recurrent or metastatic disease in 4 patients (2 with bladder tumor, 2 with testicular tumor). Although there was no correlation between the levels of serum TPA and serum PAP, the level of serum TPA tended to change in parallel with the level of serum AFP or HCG in 3 patients with testicular tumor.

A 69-year-old man visited our clinic with the chief complaint of macroscopic hematuria. On CT scanning and renal arteriography, a round tumor about 3 cm in diameter on the frontlateral phase of the left kidney and another tumor ranging from the upper pole to the center of the right kidney were recognized. Under the diagnosis of bilateral renal tumor, first in November 1980 left partial nephrectomy was performed to extirpate the tumor. Then, upon recovery from postoperative transient renal hypofunction, right nephrectomy was performed in January 1981. After the operation renal hypofunction was noted again, but in March of the same year he was discharged as his creatinine value was stabilized to 3 approximately 4 mg/dl. Histopathologically the tumor of the left kidney was clear cell subtype and that of the right kidney was granular cell subtype of renal cell carcinoma. He has been followed up under administration of PSK and CQ in the outpatient clinic. As of January, 1985 he is well without recurrence or metastasis.

It has long known that H2S is sometimes encountered during excavation in the Hiroshima delta. In order to secure information necessary to the improvement of working conditions in this area, we investigated the generation of H2S where work was being done on the Hiroshima sewage system. Using the shield method, we measured the concentration of H2S in the air around eight work sites, and we also measured pH, total sulfide, SO4(2-), C1-, Mg2+, and salinity in samples of water collected at the sites and from nearby wells. The ventilation volume was calculated from the measurement value of air movement with reference to ventilator capacity. The past situation of H2S generation at the sites was also investigated. The survey was conducted from August 30 to September 4, 1982, using the shield method. Concentrations of H2S from 0.8 to 7 ppm were detected in the air at four of the eight sites. Total sulfide varying from a trace to 8.5 mg/l was found at six sites, which included the four where H2S was found in the air. SO4(2-), C1-, and Mg2+ were found in high concentration in water in which sulfide was detected, and the same samples tended to have high salinity. At some of the sites, ventilation was implemented up to a maximum of 3,000 m3/h according to the concentration of H2S. At the sewage system construction sites covered in this survey, H2S concentration was kept below the permissible level of 10 ppm, and it may be concluded that adequate safety precautions have been taken.

Twenty-three patients, who underwent radical cystectomy and pelvic lymph node dissection for bladder carcinoma from November 1985 to November 1987, were studied pathologically. We evaluated the rate, position and morphology of metastasis into the neurovascular corridor or paracystium. The stages of the twenty-three patients were G1 1, G2 10, G3 12 and pT1a 1, pT1b 4, pT2 8, pT3a 2, pT3b 7, pT4 1. Of the 23 specimens, 22 (95%) were found to contain metastasis in the connective tissue of the paracystium. Lymph node metastasis was recognized in four patients (17%). Metastasis in connective tissue around the iliac lymph node was recognized in 5 patients (22%). Of these 5 patients, 3 were free from lymph node metastasis. The morphological pattern of metastasis was ranged from a few tumor cells to massive tumor cells with proliferation of fibroblasts. The existence of metastasis in the paracystium should be evaluated morphologically for urinary bladder carcinoma.

The established cell lines from human prostatic cancer, such as Duke 145, 8PC93, and 19PC93, were examined in terms of their producing activity of acid phosphatase (ACP) and sensitivity to sex hormones. The results obtained are summarized. 1. ACP producing activity ACP was estimated with phenyl phosphate as a substrate. Values of the materials from each of the cells extracted with 5% Triton X-100 were Duke 145 (6.1 u/mg), 8PC93 (40.6 u/mg), and 19PC93 (40.4 u/mg), respectively. Activities of ACP were prohibited by the presence of L-tartrate. Histochemistry of ACP was demonstrated by azo-dye staining procedure, revealing the positive reactions in the cytoplasms of 8PC93 and 19PC93 cells, but weak reaction in duke 145 cells. Disk polyacrylamide gel electrophoresis (D-PAGE) was employed for ACP analysis of the cell extracts with 5% Tryton X-100 treatment. Two main bands were observed near original point and at another point proposed as ACP-2. These ACP positive reactions on the gels were also inhibited by the presence of L-tartrate in staining solution. In the case of Duke 145 cell material, the intensity of the reaction was observed weak in those specific two bands. 2. Hormone effects to the cells The prostatic cancer cells were examined in terms of sensitivity to sex steroid hormones such as androsterone, progesterone, estrone, estradiol, and estriol, by a colony formation method. Fifty percent reduction in colony formation of the 8PC93 and 19PC93 cells was found at the concentration of ca. 1.5 micrograms/ml in the case using progesterone or estrone, or estradiol, while 50% reduction of the Duke 145 cells was observed at 5 micrograms/ml only in a case using progesterone.