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Herein, we investigated the pharmacokinetic (PK) profile of nedaplatin (cis-diamine-glycolateplatinum; CDGP) in a hemodialysis (HD) patient with advanced esophageal squamous cell carcinoma (ESCC) by administering the CDGP immediately prior to HD. Our patient was treated with CDGP (45 mg/m 2 for a total dose of 60.2 mg) and 5-fluorouracil (560 mg/m 2 for a total dose of 750 mg) before initiating HD. The total platinum (Pt) concentration (Pt _total ) and free Pt concentration (Pt _free ) 2 h after completion of HD were 0.4 μg/mL and 0.3 μg/mL, respectively. The removal rates of Pt _total and Pt _free by the dialyzer were 76.5% and 84.6%, respectively. Twenty-four hours after CDGP administration, the Pt _free was below the detection limit of the method of analysis. Pt _free within the range of the recommended CDGP target AUC 0-24 was 8-10 μg/mL•h, the AUC 0-24 of Pt _total and Pt _free were 16.5 μg/mL•h and 8.8 μg/mL•h, respectively. We conclude that HD should be performed after the end of CDGP infusion as part of the CDGP chemotherapy regimen for HD patients with ESCC, and suggest that HD is effective for obtaining a PK profile of CDGP similar to patients with normal renal function.

This study's purpose was to gain insight into practical strategies for improving community palliative care in Japan. Focus groups were held involving physicians, medical social workers, and nurses of 6 cancer centers, and the collected data were qualitatively analyzed. A total of 19 categories were examined. They were related to 1 )education for medical health care professionals about palliative care, 2 )public education about palliative care, 3 )specialized palliative care service, and 4 ) constructing a community palliative care network. Additionally, 7 categories related to medical and social systems were analyzed. The list proposed in this study may be effective for systematically understanding approaches to improve community palliative care. The implementation of nationwide focus groups which rapidly disclose their results may contribute to improving regional palliative care at a national level.

Unlabelled: In surgical treatment of cervical radiculopathy, localization of the responsible lesions by various imaging modalities is essential. Among them, MRI is non-invasive and plays a primary role in the assessment of spinal radicular symptoms. However, demonstration of nerve root compression is sometimes difficult by the conventional methods of MRI, such as T1 weighted (T1W) and T2 weighted (T2W) sagittal or axial images. We have applied a new technique of curved coronal multiplanar reconstruction (MPR) imaging for the diagnosis of cervical radiculopathy., Methods: Ten patients (4 male, 6 female) with ages between 31 and 79 year-old, who had clinical diagnosis of cervical radiculopathy, were included in this study. Seven patients underwent anterior key-hole foraminotomy to decompress the nerve root with successful results. All the patients had 3D MRI studies, such as true fast imaging with steady-state precession (FISP), 3DT2W sampling perfection with application optimized contrasts using different fillip angle evolution (SPACE), and 3D multi-echo data image combination (MEDIC) imagings in addition to the routine MRI (1.5 T Avanto, Siemens, Germany) with a phased array coil. The curved coronal MPR images were produced from these MRI data using a workstation., Results: The nerve root compression was diagnosed by curved coronal MPR images in all the patients. The compression sites were compatible with those of the operative findings in 7 patients, who underwent surgical treatment. The MEDIC imagings were the most demonstrable to visualize the nerve root, while the 3D-space imagings were the next., Conclusion: The curved coronal MPR imaging is useful for the diagnosis of accurate localization of the compressing lesions in patients with cervical radiculopathy.

Sjögren's syndrome (SS) is an autoimmune disease that affects exocrine glands including salivary and lacrimal glands. It is characterized by lymphocytic infiltration into exocrine glands, leading to dry mouth and eyes. A number of auto-antibodies, such as anti-SS-A and SS-B antibodies, are detected in patients with SS. However, no SS-specific pathologic auto-antibodies have yet been found in this condition. M3 muscarinic acetylcholine receptor (M3R) plays a crucial role in the secretion of saliva from salivary glands. It is reported that some patients with SS carried inhibitory auto-antibodies against M3R. To clarify the epitopes and function of anti-M3R antibodies in SS, we examined antibodies to the extracellular domains (N terminal region, the first, second, and third extracellular loop) of M3R by ELISA using synthesized peptide antigens encoding these domains in 42 SS and 42 healthy controls (HC). Titers and positivity of anti-M3R antibodies to every extracellular domain of M3R were significantly higher in SS than in HC. For functional analysis, human salivary gland (HSG) cells were pre-cultured with IgG from anti-M3R antibodies positive SS, negative SS, and HC. HSG cells were stimulated with cevimeline hydrochloride and intracellular calcium concentration ([Ca(2+)](i)) was measured. IgG from anti-M3R antibodies to the second loop positive SS inhibited the increase of [Ca(2+)](i), but IgG from antibodies to the N terminal or the first loop positive SS enhanced it, while IgG from antibodies to the third loop positive SS showed no effect on [Ca(2+)](i) as well as IgG from anti-M3R antibodies negative SS and HC. These findings indicated the presence of several B cell epitopes on M3R in SS and effect of anti-M3R antibodies on the salivary secretion might differ with these epitopes.

Peritoneal dialysis (PD) is recommended as the first line of treatment for end-stage renal disease patients in terms of integrated renal replacement therapy (RRT), since PD can preserve residual renal function and fluid homeostasis. However, few analyses have been studied regarding the risk factors for death among patients, including cases transferred from PD. This study retrospectively examined 98 patients (63-years-old, male/female ratio: 59/39, non-DM/DM: 57/41) who started PD for their first RRT between Jan. 1999 and Dec. 2003 in a single center. The risk factors for patient death were evaluated During the average observational period of 28 months, 35 cases (35.7%) were withdrawn from PD, and among these, 24 patients (24.5%) died (including 7 cases after transferal to HD). The leading causes of death were cardiovascular disease (CVD) and infectious disease in 8, respectively (33.3% each) and no cases were found who developed encapsulating peritoneal sclerosis. As compared to living patients, the group of patients who died was significantly older and had a high frequency of CVD history. Their serum albumin (Alb) level was significantly lower, whereas the D/P (dialysate/plasma) creatinine (Creat) ratio as well as diastolic blood pressure was higher. In the Cox Hazard model, D/P Creat ratio >0.65 (category high/high average), DM nephropathy and history of CVD were independent predictors of death (hazard ratio (HR): 1.78, 95% CI: 1.10-2.94, HR: 1.81, 95% CI: 1.11-3.11, HR: 2.23, 95% CI: 1.37-3.73). These results suggest that DM nephropathy, history of CVD and higher peritoneal permeability at PD initiation are independent risk factors of death in patients starting PD for their first RRT. Hence, a strict follow-up is needed in these patients.

Purpose: In our department, prochlorperazine, a D2 receptor antagonist, was previously administered to prevent nausea related to the introduction of opioids. However, we always had to consider extrapyramidal symptoms. Since August 2006, perospirone has been administered to all patients who have commenced oral opioid therapy, to prevent nausea. In this study, we investigated its usefulness in the prevention of nausea., Methods: Perospirone (4 or 8 mg, once a day) was combined in all patients in whom opioid therapy was introduced with oxycodone at 10 mg/day. We retrospectively examined the presence or absence of nausea within 1 week., Results: Oxycodone-related nausea occurred in 1 of 25 patients. There were no adverse reactions such as extrapyramidal symptoms., Conclusion: These results suggest the usefulness of perospirone for the prevention of nausea related to the intro- duction of opioids.

A 53-year-old woman visited a clinic for stridor and dyspnea, and was treated with steroid and heparin for bronchial asthma and pulmonary embolism. She was later admitted to our hospital for progressive dyspnea. Blood gas analysis showed severe hypoxemia with hypercapnia. Pulmonary funtion tests revealed severe obstractive pulmonary dysfunction. Chest computed tomography showed a mosaic perfusion pattern. Ventilation-perfusion scanning showed bilateral multiple matched defects, especially in the basal region. Since specimens of Video-assisted thoracoscopic surgical (VATS) lung biopsy showed lymphocytic infiltration in membranous bronchiole and occlusion of the membranous bronchiole lumen, bronchiolitis obliterans was diagnosed. We initiated treatment with steroids, macrolides and bronchodilators and her condition stabilized. Although these therapies did not cure the BO, they did retard its progression.

A 72-year-old woman visited a clinic for anorexia and general fatigue but no particular abnormality was detected by routine examination at that time. Thereafter, she experienced gradually increasing dyspnea and chest X ray showed right pleural effusion. Idiopathic chylothorax was diagnosed due to the milky effusion with a high concentration of triglyceride (2618 mg/dl) and no apparent causative disease. Irrespective of treatments including dietary restriction, drainage of the pleural space, and somatostatin injections, her effusion did not reduce. The leakage of lymph fluid from the right posterior mediastinum was identified by lymphatic scintigraphy and she was successfully treated with surgical ligation of the thoracic ducts.

75% of cancer patients have pain, which can greatly affect their quality of life. In cancer patients, not only physical pain but also total pain must be treated. Cancer pain can be classified as nociceptive pain or neuropathic pain according to neural mechanism. It is important to consider the underlying cause and mechanism. In 80% to 90% of patients, pain can be alleviated by the WHO (World Health Organization) guidelines, which have been established as standard treatment for cancer pain. Therefore, all physicians involved in cancer care should become skilled in this analgesic therapy. This article mainly explains the characteristics of cancer pain and the WHO guidelines.

Using questionnaires for 281 healthy subjects and 139 asthmatic patients in 5 medical institutes, we investigated the relationship between the common cold and acute asthma. The frequency of the common cold, duration to recovery and absences from work were slightly higher in asthmatics than healthy subjects. Acute asthma occurred in a few days following common cold and subsided at the end of or after the common cold. Evaluation of the types of common cold revealed that the cold, which causes upper respiratory symptoms, frequently induced acute asthma. Bronchodilators seemed to be less effective for cold-induced asthma. Collectively, these results suggested that the common cold induces acute asthma not through virus-induced direct inflammatory responses but through indirect immunological responses. Through these questionnaires, we realized that it is important to prevent the common cold, a trigger of asthma attacks. As the guidelines of asthma therapy recommended, the use of corticosteroid must be considered when acute asthma attacks occur.

A thirty-eight year old man took about 180 tablets of Seirogan. He was unconscious and had dyspnea with dark brown urine on admission. He recovered gradually after initial treatment. Seirogan contains a phenolic component. Symptoms and signs of poisoning are unconsciousness, convulsion, digestive tract disorder, pulmonary edema, hepatic failure, renal failure, and miosis. Clinical features include dark brown urine. On day 7, he again showed signs of creosote poisoning: relapse of unconsciousness and dark colored urine. Plasma concentration of phenol determined on the day before the relapse was much higher than that expected from the half-life of blood phenol. It is reported that Creosote poisoning results in a decrease in the intestinal peristalsis, or paralytic ileus. We would like to emphasize that a relapse of Creosote poisoning may occur due to possible delayed absorption of the Seirogan tablets.

Infection caused by metallo beta-lactamase (MBL)-producing bacteria have been increasingly reported in Japan in recent years. We investigated the prevalence, clinical backgrounds and molecular epidemiology of MBL-producing Serratia marcescens strains isolated from blood cultures at our university hospital between 1991 and 2000. Forty-three S. marcescens strains were isolated in the period, and the incidence reached about 2% total bacteria detection in 1998 and 1999. There were 13 ceftazidime-resistant strains (31%), and five of them produced MBL. MICs of imipenem (IPM) were 4-16 mg/ml, of which one strain was susceptible to IPM. Of the five MBL-producers, four were obtained from a tertiary emergency ward, the underlying diseases being either serious trauma or cerebrovascular diseases. The other was isolated from a patient who underwent kidney transplantation. S. marcescens was no longer isolated from patients after administration of aztreonam (AZT), implying that AZT was clinically effective. When analyzed genetically using the AP-PCR technique, the patterns were identical among strains isolated in 1996, 1997 and 1998 and those isolated in 1999 and 2000 respectively, suggesting that the same strains may have inhabited the hospital wards for prolonged periods. Countermeasures against nosocomial infection was undertaken thereafter, resulting in reduction of isolation frequency. It cannot be excluded that the resistant bacteria spread as the amount of carbapenem consumption increased. Prudent use of antibiotics is mandatory to prevent further dissemination of such MBL producers.

Segmental SMANCS Lipiodol TAE (Seg. SMANCS Lp-TAE) using SMANCS was used to treat HCC in 58 patients and was evaluated in comparison with Seg. Lp-TAE using Epirubicin performed in 50 patients with respect to the course of atrophy of the embolized area, recurrence rate and side effects. On serial CT (Lp-CT) performed after TAE, in cases with P type in which the tumor is present in the periphery of the embolized area and showing Type I homogeneous accumulation of Lp within the tumor, the incidence of atrophy in the embolized area including the tumor was high and the recurrence rate was low. Although no significant difference in the recurrence rate was noted between the groups in which SMANCS and EPI were used, there were more cases with marked atrophy and a lower recurrence rate in the former. No difference was found in post-procedural side effects such as fever between the two groups, while hypotension was rarely observed during the procedure in the group in which SMANCS was used and was easily managed with intravenous steroids. The present results suggest that Seg. SMANCS Lp-TAE is an effective local treatment for HCC limited to a subsegment or segment.

The anticancer drug distribution in pelvic arterial infusion chemotherapy with bilateral internal iliac arterial catheter placement with coil occlusion of the superior, inferior and obturator arteries was indirectly evaluated by serially performed DSA, CTA and RI on 18 patients with pelvic malignancies. The distribution was judged to be Excellent (E), defined as uniform distribution in the entire lesion alone, in 9 of 18 patients (50%) evaluated prior to the start of the arterial infusion (AI), and as Good (G), defined as uniform distribution in the entire lesion and partly on an unaffected portion, in 9 (50%). Of the 11 patients evaluated after 7 times AI, E was found in 3 patients (27%), G in 7 (64%) and Fair (F), defined as distribution with a defect in the lesion, in one patient (9%). Of the 11 patients evaluated after 14 AI, E was found in 5 (45%), G in 4 (36%) and F in 2 (18%). Of the 7 patients evaluated after 21 AI, E was found in 2 (29%), G in 4 (57%) and F in one (14%). G was found in 2 of 2 patients (100%) evaluated after 28 AI. These results suggest that this method can maintain a favorable anticancer drug distribution even after multiple sessions of AI.

The usefulness of color Doppler sonography for the assessment of intrahepatic hemodynamics and shunt patency was evaluated in a total of eight patients in whom the intrahepatic hemodynamics before and after transjugular intrahepatic portosystemic shunt (TIPS) could be serially examined by color Doppler sonography. In six of these patients the serial sonographic examinations could be followed for more than one year after TIPS creation. Within one month after TIPS creation, Vmax in the shunt was ranged from 87 cm/sec to 242 cm/sec (mean: 142.5 cm/ sec), and the flow direction in the right anterior portal vein was reversed in all patients. More than 70% stenosis of the shunt could be diagnosed by color Doppler sonography. When the shunt was confirmed by angiography to be more than 70% stenotic or occluded, Vmax in the shunt was decreased to less than 50 cm/sec and the blood flow in the right anterior portal vein become hepatopetal. From three months before stenosis or occlusion of the shunt, it was confirmed that Vmax in the shunt was less than 70 cm/sec or the blood flow of right anterior portal vein was hepatopetal. Color Doppler sonography was useful for the assessment of intrahepatic hemodynamics, and shunt patency and prediction of shunt stenosis or occlusion following TIPS creation.

As chemoembolotherapy (TAE) for relatively small hepatocellular carcinoma (HCC) including small HCC of less than 2 cm in diameter, which is restricted to a sub-subsegment, subsegment or segment of the liver, segmental Lp-TAE using Lipiodol (Lp) mixed with an anticancer agent, which includes subsegmental and sub-sub-segmental therapy, not restricted to the tumor-bearing segment, is expected to move to the forefront of HCC treatments and also causes fewer complications and less strain to the patient. Of the 15 cases that underwent surgery following segmental Lp-TAE, complete necrosis was found histopathologically in more than 80% of the main tumor, satellite nodules in the embolized region and areas of capsular invasion. Its therapeutic efficacy for 51 cases with tumors smaller than 3 cm was comparable to that of surgery.

We compared power Doppler sonography (PDS) with conventional color Doppler sonography (CDS) in the visualization of intratumoral blood flow of hepatocellular carcinoma (HCC) and evaluated the usefulness of PDS for assessing of the effects of TAE with Lipiodol and anticancer agents (Lp-TAE) and for the diagnosis of recurrence of HCC after Lp-TAE. The ability of PDS and CDS to visualize intratumoral blood flow was compared in 36 patients with HCC, and the usefulness of PDS for the diagnosis of HCC was evaluated. Also, in 17 patients with HCC who underwent Lp-TAE, the usefulness of PDS for evaluating the therapeutic effects of Lp-TAE and the diagnosis of recurrence after Lp-TAE was examined. The ability of PDS to visualize intratumoral blood flow and delineate tortuous and meandering intratumoral vasculature was superior to that of CDS. The effects of Lp-TAE could be evaluated and recurrence detected accurately and easily by PDS on the basis of residual intratumoral blood flow and the appearance of new blood flow. PDS is expected to achieve widespread acceptance as a useful imaging modality for the diagnosis of HCC, assessment of therapeutic effects of TAE, and detection of recurrence of HCC after TAE.

Prostacyclin (PGI2) is a bioactive substance produced by vascular endothelial cells, which exerts powerful vasodilative and anti-platelet actions. Patients with pulmonary hypertension have an imbalance between vasodilative PGI2 and vasoconstrictive thromboxane B2 (TXB2). Treatment with vasodilative agents is essential for such patients. Continuous intravenous infusion of PGI2 is an effective treatment of primary pulmonary hypertension in terms of exercise capacity and survival rate. We tested a new stable PGI2 analogue, beraprost sodium (Procyclin, Dornar) suitable for oral administration, in patients with primary and secondary pulmonary hypertension. A short-term study of cardiac catheterization in four patients with primary pulmonary hypertension showed a 15 +/- 12% reduction in mean pulmonary artery pressure in three of the four patients, and a 24 +/- 22% decrease in pulmonary vascular resistance in all four patients. Cardiac index increased by 27 +/- 14% in three of the four patients. Among three patients with secondary pulmonary hypertension, there was a 7% reduction in pulmonary artery pressure in one patient, and a 24 +/- 14% decrease in pulmonary vascular resistance in all three patients. In a long-term study (23 +/- 11 months), NYHA functional class improved from 3.0 +/- 0.7 to 2.4 +/- 0.5 in two of the five patients with primary pulmonary hypertension. Although the radiographic cardiothoracic ratio was not significantly improved, cardiac index increased by 78 +/- 60% in four of the five patients. Only two patients, one with primary and one with secondary pulmonary hypertension, died during the long-term follow-up period. Plasma TXB2/6-keto prostaglandin F1 alpha ratio decreased from 8.1 +/- 8.7 to 1.5 +/- 0.4. The optimal dose remains uncertain, but the initial dosage of 40-60 micrograms/day given in three to four doses for adult patients is considered to be acceptable. Side effects such as flushing face, headache, vomiting, and nausea were mild and resolved when the dose was reduced. Oral PGI2, beraprost, appears to be an effective and possibly adequate substitute for intravenous vasodilators in pulmonary hypertension for both short- and long-term management.

The relationship between personality types and the symptoms of emesis gravidarum in pregnant women was analyzed by means of the Cattel personality test (revised by Nishizono) performed in early and mid pregnancy. Personality types were classified into five from cyclothymia A to schizothymia E. As for emesis, the patients were also classified into three groups, severe (35), mild (41) and none (19), according to the severity and duration of the symptoms. As a result, there was no significant difference between the types and the symptoms, but significant differences were seen in interpersonal attitudes, especially in sociality and dominative propensity, which were constituents of the personality type. The results of the analysis suggested that the patients who revealed disunification tended to express strong emesis as a somatic language. These results therefore indicate the necessity for counseling about personality without simply explaining it as their predisposing constitution, when we encounter strongly emetic pregnant women.

A rare case of primary orbital lymphoma with macroglobulinemia was reported. The patient was a 74-year-old male with bilateral orbital tumor. Exophthalmos and eye movement disturbance appeared in his left eye. Blood analysis showed a marked increase of serum immunoglobulin M. Immunochemical study showed 7,097 (mg/dl). The left tumor was partially removed and examined histopathologically and immunohistochemically. H.E. staining revealed the proliferation of lymphoplasmacytoid cells. Immunocytochemical staining showed these cells to be immunoglobulin G (-), immunoglobulin A (-), immunoglobulin M (+), immunoglobulin light chi-chain (-), immunoglobulin light lambda-chain (+), LCA (+), L-26(PAN-B)(+), MT-1(-), and UCHL(-). Based on these results, our diagnosis was non-Hodgkin's lymphoma of the diffuse small, lymphoplasmacytoid type.

Renal ablation by transcatheter renal arterial embolization (TAE) was performed in 10 patients with benign renal disease (hydronephrosis n = 6; renovascular hypertension n = 3; nephrotic syndrome n = 1). Each affected kidney had little or no renal function. Six patients with hydronephrosis were treated with TAE using absolute ethanol alone in three patients and the combination of absolute ethanol and gelatin sponge in the other three. Each patient was followed by sclerotherapy of the pelvocalyceal system via nephrostomy using absolute ethanol. In four of the six patients, the embolized kidney had no urine, and there was very little urine in the remaining two. The size of the embolized kidney was markedly decreased on CT. The three patients with renovascular hypertension were pre-studied by selective and renal vein sampling for PRA, and the kidney excreting higher renin was embolized by TAE with absolute ethanol. Blood pressure has become manageable without antihypertensive drug in two patients and with a reduced amount of drug in one. The patient with nephrotic syndrome had end stage renal failure and showed significant protein excretion. To prevent further protein loss, both kidneys were embolized with stainless steel coils. Urine output was significantly decreased, and consequently, hypoalbuminemia improved. All patients tolerated the procedure well, and there were no significant complications. Renal ablation by TAE may be an alternative to surgical treatment in selected patients with benign renal disease, particularly in patients with contraindications to surgery and in the elderly. Absolute ethanol and gelatin sponge seem safe and effective for TAE in patients with hydronephrosis and renovascular hypertension. For hydronephrosis, we recommend combining TAE with sclerotherapy of the pelvocalyceal system via nephrostomy using absolute ethanol. Though we successfully applied steel coil for the patient with nephrotic syndrome, absolute ethanol may be equally effective.

To investigate the usefulness of MRI oral contrast media in enhancing the entire small intestine using FerriSeltz (Otsuka Pharmaceuticals, Tokyo), which contains ferric ammonium citrate, we compared the relaxation times and taste of 7 kinds of contrast media (Milk FerriSeltz A-G) that contain FerriSeltz dissolved in 7 different ratios of distilled water-milk. We also compared the homogeneity of the contrast enhancement of the entire small intestine on T1-weighted images between Milk FerriSeltz-F (a mixture of distilled water and milk at a ratio of 1:5 with FerriSeltz), which was found to be the best contrast medium based on the relaxation times and taste, and Milk FerriSeltz-A (distilled water with FerriSeltz) in 10 healthy volunteers. The T1 and T2 values decreased as the proportion of milk increased. The T1 and T2 values of Milk FerriSeltz-F were 71 msec and 28 msec, markedly shorter than those of Milk FerriSeltz-A (340 msec and 290 msec). T1-weighted images taken with Milk FerriSeltz-F showed more homogeneous enhancement of the entire small intestine than those taken with Milk FerriSeltz-A. There were no adverse effects in these 10 volunteers. Milk FerriSeltz-F seems to be an ideal oral contrast medium for enhancement of the entire small intestine.

Immunological features and the production of interleukin-6 (IL-6) in 4 patients with cardiac myxoma were studied. The patients' age ranged from 11 years old to 57 years old; all 4 patients were female. Case 1, an 11-year-old female patient with myxoma located in the right ventricle, was considered to be a familial case. Her mother had myxomas in the right and left atrium, and had undergone removal of both tumors 3 years before. Peripheral blood examination revealed various inflammatory parameters in all of these patients. White blood cell (WBC) count was over 8,000/cmm in 3 of the 4 patients, positive CRP was found in 2 patients, IgG was higher than 1,500 mg/dl in 3 patients, positive anti-nuclear antibody was seen in 1 patient, and positive rheumatoid factor was identified in 1 patient. The OKT 4/8 ratio of lymphocyte subpopulation was 4.65 in one patient. The lymphocyte mitogenic response to PHA was increased in 2 patients. Serum IL-6 increased in 3 of 4 patients, and returned to normal within 3 to 4 weeks after operation. The IL-6 concentration in the homogenized sample remarkably increased in all 4 patients. Tumors larger than 4 cm contained higher tissue IL-6 concentrations than those smaller than 2 cm. The cultured myxoma cells produced abundant IL-6 in the culture medium supernatant. We conclude that inflammatory signs and immunological abnormalities are common in patients with large cardiac myxoma, and, in addition, serum IL-6 levels may increase in such patients.(ABSTRACT TRUNCATED AT 250 WORDS)

The distribution of blood flow was determined from the distribution of CO2 by US performed during the infusion of CO2 microbubbles via an implantable port (IP-CO2US) in intraarterial chemotherapy for hepatic tumor, and the usefulness of this method in determining tumor vascularity and evaluating the effects of therapy was investigated. A total of 16 patients, 12 of whom had metastatic liver tumor, two hepatocellular carcinoma, one gall bladder carcinoma, and one cholangiocellular carcinoma were studied. The enhanced areas in the liver in 16 patients in whom IP-CO2US was performed a total of 24 times were consistent in all cases with the enhanced areas demonstrated by IP-RI angiography performed a total of 10 times within 10 days, and were also consistent with one exception with the enhanced areas demonstrated by IP-CTA performed 14 times. The tumor detection rate was markedly higher with IP-CO2US than with plain US or IP-DSA, and was similar to that of IP-CTA. Evaluation of the vascularity of individual nodules by IP-CO2US surpassed that by IP-DSA, and was similar to that of IP-CTA. It was demonstrated that blood flow distribution (intrahepatic drug distribution) can be equally well grasped with IP-CO2US, which is a simple and convenient method, as with IP-RI angiography. It was also suggested that IP-CO2US is useful in the evaluation of tumor vascularity and the effect of therapy.

To determine the usefulness of alpha-fetoprotein (AFP) in determining recurrence of HCC after interventional angiography (IVA) and to define the relation between AFP and the imaging diagnosis of HCC recurrence, changes in AFP values in 160 patients with hepatocellular carcinoma who were treated by IVA > or = two times were classified into four patterns: A: the AFP value was decreased after the first IVA, increased at recurrence and decreased again after the second IVA; B: the AFP value was unchanged after the first IVA, but increased at recurrence and decreased after the second IVA; C: the AFP value was decreased after the first IVA, but was not increased at recurrence; D: the AFP value showed no change. The frequency of each AFP pattern and the diagnosis of recurrence by AFP were determined. The relation between tumor type and AFP was defined. Pattern A was the most frequently detected. In 62.6%, AFP was increased at recurrence (A and B), and there was a positive correlation between changes in the AFP value and the findings of imaging diagnosis. In another 37.5%, AFP was not increased at recurrence (C and D), and therefore, the diagnosis of HCC recurrence by imaging methods was very important.

The histopathological and cytological findings of a caruncular oxyphilic adenoma (oncocytoma) in a 85 year-old male is described. The columnar or polygonal tumor cells contained numerous eosinophilic fine granules (mitochondria). They showed papillary proliferation and cyst formation. Electron microscopically, some tumor cells contained amorphous cytoplasm and small numbers of mitochondria in their apical snout, and secreted the contents in the extracellular spaces. It seemed that the tumor cells originated from the ductal epithelia in the caruncle and microscopically some cells simulated apocrine type secretion.

To determine the effect of appraising subsegmental or segmental transarterial embolization with Lipiodol mixed with anticancer drugs followed by gelatin particles (Segmental Lp-TAE) on inoperable hepatocellular carcinoma, we examined CT patterns and therapeutic results in 57 patients after Segmental Lp-TAE. Fifty-six tumors including 47 tumors less than 5 cm in size were the nodular type and 1 tumor was the massive type. The mean tumor size was 3.6 cm and the mean amount of Lipiodol was 4.4 ml. Portal veins in the embolized segment were highly visualized by injected Lipiodol on plain film immediately after Segmental Lp-TAE. On the follow-up CT, the size of the tumor with dense Lipiodol accumulation were reduced in all cases, and atrophy of the embolized segment was recognized. Forty-four of the 57 patients are alive, with the longest surviving patient still alive at 4 years and 5 months. Seventeen patients have survived for more than 2 years (direct crude survival rate: 65.0%), with the cumulative survival rates 93.2% at 1 year, 71.6% at 2 years. No recurrence was recognized in 33 of the 41 patients (80.0%) that were followed up for more than 1 year after Segmental Lp-TAE is a useful therapeutic method for hepatocellular carcinoma.

The authors cytopathologically examined pseudohypopyon in a 10 year-old boy with acute monoblastic leukemia. The ultrastructural investigation showed that the stage of leukemic cells was monoblastic, which resembled promonocytes. The ultrastructural findings of pseudohypopyon in acute monoblastic leukemia has never been reported.

We report a case of sarcoid granulomatous tubulointerstitial nephritis diagnosed by renal biopsy. A 60-year-old man presented with productive cough, and exertional dyspnea of 3 months duration. A chest X-ray film revealed diffuse reticulonodular infiltrates in both lung fields. A transbronchial lung biopsy specimen showed inflammation of the alveolar septum associated with non-caseating granulomas. The patient also had tubular proteinuria and glucosuria. Ga-scintigraphy demonstrated an abnormal accumulation of gallium in both lungs and kidneys. Renal function tests revealed tubular dysfunction. Tubulointerstitial nephropathy was suspected. A renal biopsy specimen exhibited tubulointerstitial nephritis associated with numerous non-caseating granulomas, similar to the findings of the lung biopsy specimen. No glomerular abnormalities were evident. Later, a scalene node biopsy confirmed the diagnosis of sarcoidosis. Prednisolone therapy yielded a favorable outcome for both the renal and pulmonary involvement. During the corticosteroid therapy, measurement of the urinary beta-2-microglobulin concentration proved a valuable monitoring tool for assessing the recovery of the tubular impairment.

Cellular elements, including retinal pigment epithelia, were removed by the cell maceration method to obtain a three-dimensional view of the collagen fibrillar networks of Bruch's membrane. A bird's eye view of the inner collagenous zone of Bruch's membrane was obtained using the eyes of albino rabbits and Japanese monkeys. The eyes were treated with a low concentration of NaOH for several days and then observed with a scanning electron microscope. This procedure allowed the exposed inner collagenous zone of Bruch's membrane to be observed. In addition, the outer collagenous zone was also be observed in some of the specimens. Both zones were formed by dense lattices of fine collagen fibrils, and these fibrils frequently formed bundles in the outer collagenous zone. In the posterior poles of the eyes obtained from Japanese monkeys, a network of wavy fine collagen fibrils was observed. In both outer and inner collagenous zones, most of the collagen fibrils ran parallel to the retina. Fenestration of the sheet-like elastic layer was frequently observed through gaps in the thin collagen fibrillar network of the inner collagenous zone. The method employed in this study was considered suitable to obtain a wide bird's eye view of the collagenous zone of Bruch's membrane.

A 64 year-old female complained of left upper lid swelling. Painless mass lesions were found in her bilateral lacrimal gland areas. She also complained of a dry sensation in both eyes and her mouth. The rose bengal test, Schirmer's test and fluorescein dye test were positive. Lip biopsy revealed chronic sialoadenitis and rheumatoid factor titer was elevated. Anti-nuclear and anti-RNP antibodies were positive. Anti-SS-A and anti-SS-B antibodies were both negative. Left pre-and post auricular, cervical and inguinal lymph nodes were palpable. Excisional biopsies of bilateral orbital lesions and an inguinal lymph node revealed the presence of reactive lymphoid hyperplasia in the right orbit, and B cell type, diffuse, large cell lymphoma, in the left orbit and inguinal lymph node. Intensive chemotherapy resulted in complete remission. Lacrimal gland lymphoma must be considered when examining cases of Sjogren's syndrome.

Japanese monkey and albino rabbit choroid were treated with hot-formic acid to remove the cellular elements and the extracellular matrices excluding the elastic tissues so that both three-dimensional and bird's eye views of the elastic layer of Bruch's membrane could be obtained. The only elastic layer was extracted and observed with a scanning electron microscope. Elastic layers were frequently extracted as translucent monolayered sheets with oval, sector-shaped fenestrations of varying sizes. Elastic fibers of 100-200nm in diameter crossed each other in these fenestrations. Other fine fibers connecting these elastic fibers and their sheet-like elastic plate were also observed. In Japanese monkey eyes, lattice structures formed by thick elastic fibers, 200-300nm in diameter, were conspicuous. This method proved suitable for the observation of the three-dimensional structure of the elastic layer of Bruch's membrane.

A case of intraocular and brain malignant lymphoma was presented in which histopathological and immunohistochemical analysis of the necropsy eyes and brain lesions were performed. Lymphoma cells infiltrated into both eyes and the brain. The tumor cells could be found only in the vitreous cavity, not in other ocular tissues. Lymphoma cells were morphologically better preserved in the vitreous cavity, than in the vitrectomized specimen. Applying immunoperoxidase techniques to the necropsy eyes and brain lesions, the lymphoma cells were identified a B cell type, and the diagnosis of vitreous biopsy specimen was confirmed.

We developed an analysis system for the evaluation of corneal endothelial photographs. Morphological parameters including hexagonality were analyzed semiautomatically with this system. The image analyzer used consists of an image processor MC68000 and image memories 512 x 512 x 17bytes in size. The algorithm that measures the number of apices of each cell is as follows. First, all crossing points of cell borders are detected. Then, each cell is enlarged in order by three pixels in eight directions. The number of crossing points which are overlapped with an enlarged cell is detected as the number of apices of the cell. The analysis time was 7.44 +/- 1.48 min. (mean +/- standard deviation) for 40 endothelial photographs which needed no manual trace for contrast enhancement.

Kawasaki disease (KD) is a syndrome characterized by various degrees of vasculitis in small-and medium-sized arteries. We discussed the characteristic manifestations and prognosis of 5 KD patients (male 3, female 2) with meningoencephalitis in the acute stage. The incidence was 3.7% (5 of 138 patients) in our institute. The age of onset was between 3 months and 15 months. The clinical manifestations included disturbance of consciousness and seizures; disturbance of consciousness developed in all patients in the early acute stage. The duration was between 2 and 11 days; seizures developed as status convulsions in two. Electroencephalograms (EEG) demonstrated certain abnormalities in 2 of 4 patients studied. Computed-tomographic scanning (CT scan) revealed fluid collection in the frontal extracerebral space, and monocyte-predominant pleocytosis was observed in the cerebrospinal fluid (CSF) in all 5 patients studied. The age of onset in the 5 KD patients was significantly earlier than that in non-complicated cases (n = 138, P less than 0.01). Blood hemoglobin (P less than 0.05) and hematocrit (P less than 0.05), serum total protein (P less than 0.01), and serum albumin levels (P less than 0.01) were also significantly lower. Moreover the period until CRP values turned negative was significantly longer (P less than 0.05) and erythrocyte sedimentation rate was significantly lower (P less than 0.01) in these 5 patients. It was considered that meningoencephalitis in KD may develop in cases having more severe and prolonged inflammatory changes; the clinical findings revealed a serious form of KD. We suggest that this might because by vasculitis of small arteries, arterioles, capillaries, and venules, which consists of infiltration of lymphocytes and large mononuclear cells, and edema. There was no neurological sequela in 4 of the 5 patients. However, one patient was found to have hearing difficulty 3 years after the onset. Therefore, the prognosis of meningoencephalitis in KD was considered to be generally favorable.

To evaluate the clinical significance of serum SSEA-1 level, the antigen level was measured in sera of obstetric and gynecologic patients. A positive rate was low in patients with endometriosis (9.1%), myoma uteri (0%), benign ovarian tumor (15%), cervical squamous cell carcinoma (14%) and endometrial carcinoma (18%). In this series of study, interest was that positive cases in benign ovarian tumor group were all patients with dermoid cyst. On the other hand, a high positive rate was observed among the patients with cervical adenocarcinoma (50%), primary ovarian malignancies (55%) and secondary ovarian malignancies (50%). Among the patients with ovarian malignancies, serum sialyl SSEA-1 level significantly increased according to clinical stage. In patients with positive serum sialyl SSEA-1, rising or falling of the serum level of this antigen correlated well with progression or regression of the disease. Measurement of serum CA125 was also performed in patients with ovarian malignancies, which showed a significantly higher positive rate (96%) and revealed that this antigen has no correlation with sialyl SSEA-1. A low positive rate of serum sialyl SSEA-1 level (9.1%) was observed in gravidas, while a higher positive rate (43%) in puerperas, especially within three days after parturition. This evidence should be considered when serum sialyl SSEA-1 antigen is measured as tumor marker. All these observations suggest that the measurement of serum sialyl SSEA-1 level is useful not only in the diagnosis of ovarian malignancies but for the judgment of the effect of treatment and the search for their recurrences.

The practical limitations of catheters used for infusion were studied by their types in 47 patients with hepatocellular carcinoma who were treated by Segmental Lp-TAE. For catheterization into the arterial branches of S5 and S8, a coaxial infusion catheter was helpful. However, a coaxial infusion catheter was seldom used for catheterization into the arterial branches of S6 and S7. For infusion into vessels having diameters of less than 1.9 mm at the tip end of the catheter, positive use of a coaxial infusion catheter is strongly recommendable. A Tracker-18 catheter was especially helpful for catheterization into the vessels of S5.

We experienced a case of crystalline retinopathy with crystalline deposits in the cornea and the limbal conjunctiva, and performed histological studies of the cornea, conjunctiva and peripheral blood cells. The patient was a 45-year-old man who had no abnormality in hematological studies and urinalysis. In the fundus diffuse atrophy of the retinal pigment epithelium and patchy foci of choroidal atrophy were observed, and sparkling yellowish-white spots were scattered, chiefly in the posterior region. Fluorescein angiography showed neither hyperfluorescence nor hypofluorescence at these spots. In the marginal cornea and the limbal conjunctiva crystalline deposits were observed. Histological findings by light microscopy and electron microscopy revealed sparse degeneration of epithelial cells in both the cornea and the limbal conjunctiva. But no substances corresponding to crystalline deposits could be identified. Inclusion bodies were detected including clefts in circulating lymphocytes and eosinophils. The inclusion bodies suggest that crystalline retinopathy results from a systemic metabolic abnormality.

One hundred twenty patients with cervical neoplasia were treated by conization, 78 with a carbon dioxide laser and 42 with a cold knife. Bleeding during the conization was 82.5 +/- 91.4 ml with the laser and 117.3 +/- 82.6 ml with the cold knife. The time required for the operation was 55.0 +/- 16.7 min and 37.7 +/- 10.2 min, respectively. With the aid of a local injection of epinephrine, peroperative bleeding was much less pronounced in the laser group (25.4 +/- 39.5 ml) and the time required for the operation was further shortened to 36.4 +/- 15.0 min. Six patients treated with the cold knife (14.3%) suffered postoperative hemorrhage requiring hemostasis, but only one in the laser series (1.3%). Forty-nine patients of 78 treated with the laser and 15 of 42 treated with the cold knife were subjected to conservative therapy. All of them were followed up by cytology, colposcopy and histology, and there was no failure or recurrence at either 8 weeks and 1 year after the operation. Unsatisfactory colposcopic findings developed in 9 patients (18.4%) in the laser group compared with 11 patients (73.3%) in the cold knife group. Specimens obtained after laser conization were satisfactory for use in histopathological evaluation. Conization with a carbon dioxide laser appears to be an acceptable procedure as a diagnostic method and conservative therapy for cervical neoplasia.