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To retrospectively evaluate the usefulness of multidetector computed tomography (MDCT) with multiplanar reformations (MPRs) and curved planar reformations (CPRs) for detecting protruding lesions in intraductal papillary mucinous neoplasms of the pancreas (IPMNs) as compared with single-detector CT (SDCT) and endoscopic ultrasonography (EUS).

Purpose The posterior approach is widely used in femoral hemiarthroplasty. The major problem with this approach is the high risk of postoperative dislocation. A modified posterior approach, the conjoined tendon preserving posterior approach (CPP), was developed to reduce postoperative dislocations. The objective of this multicenter study was to evaluate the efficacy and safety of hemiarthroplasty performed using the CPP approach for femoral neck fractures.Methods A total of 322 patients with femoral neck fracture, from 10 facilities, were prospectively studied. Bipolar hemiarthroplasty using the CPP approach was performed, using the same type of implants. Hip joint movement was not restricted following surgery, regardless of a patient’s cognitive status. Final follow-up was performed 9.1 ± 1.5 months after surgery.Results Hemiarthroplasty was undertaken in 320 patients using the CPP approach. The mean age, operative time, and intraoperative blood loss were 83.3 ± 7.4 years, 70.0 ± 22.7 min, and 134.8 ± 107.9 mL, respectively. No postoperative dislocations were observed during the study period. Intraoperative adverse events related to the hip joint included femoral fractures in five patients (1.6%) and trochanteric fractures in four patients (1.3%). Postoperative hip joint adverse events included a periprosthetic fracture in one patient (0.3%), deep infection in two patients (0.6%), and stem subsidence in one patient (0.3%). Postoperative deaths occurred in 23 patients (7.2%). One patient (0.3%) had a severe non-hip adverse event unrelated to surgery that prevented independent living, while five patients (1.6%) had a moderate non-hip adverse event that required treatment.Conclusion The CPP approach prevented postoperative dislocation following femoral hemiarthroplasty in elderly patients, with no CPP-associated specific adverse events.

Recent investigations indicated that hyperthermia has antitumor effects. Several interstitial hyperthermic techniques were developed, and their clinical usefulness and safety were evaluated. However, few authors have attempted to study the use of interstitial hyperthermia for the treatment of pancreatic carcinomas. Therefore the efficacy of local selective thermocoagulation by radiofrequency was evaluated in 20 patients with unresectable carcinomas of the pancreas. A laparotomy and radiofrequency heating were performed in 20 patients with unresectable pancreatic carcinomas after informed consent. Local heat coagulation was induced by a 13.56-MHz radiofrequency pulse, produced by the heating apparatus. Four 2-cm needle electrodes were placed in the tumor, in a square array, at intervals of 2 cm. The heat was then administered for 15 min at a controlled temperature of 50°C in the radiofrequency field (2 × 2 × 2 cc). All the patients were evaluated by computed tomographic scanning. Tumor markers in the blood also were assayed before and after the heating. Follow-up computed tomographic scans demonstrated that the tumor mass was enhanced heterogeneously, and after selective thermocoagulation, images revealed a change to a homogeneous low-density area. The blood levels of tumor markers decreased to below pretreatment values in 15 patients. Of the 20 cases treated with thermocoagulation, two had critical complications. One patient had septic shock, and another had gastrointestinal bleeding. The other 18 patients had no significant complications. These observations suggest that the selective thermocoagulation of tumor tissues using this equipment was relatively safe. These results justify further clinical trials for the treatment of patients with unresectable tumors without metastasis, or patients with benign pancreatic tumors such as insulinomas.

We have studied the antitumor activity and the novel DNA-self-strand-breaking mechanism of CNDAC (1-(2-C-cyano-2-deoxy-β-d-arabino-pentofuranosyl)cytosine) and its N⁴-palmitoyl derivative (CS-682). In vitro, CS-682 showed strong cytotoxicity against human tumor cells comparable with that of CNDAC; both compounds displayed a similar broad spectrum. In vivo, however, orally administered CS-682 showed a more potent activity against human tumor xenografts than CNDAC, 5'-deoxy-5-fluorouridine, 5-fluorouracil and 2',2'-difluorodeoxycytidine. Moreover, CS-682 was effective against various human organ tumor xenografts at a wide dose range and with low toxicity, and was effective against P388 leukemic cells resistant to mitomycin-C, vincristine, 5-fluorouracil or cisplatin in syngeneic mice. CNDAC, an active metabolite of CS-682, had a prolonged plasma half-life after repeated oral administrations of CS-682 but not after oral administrations of CNDAC itself. This difference may partially explain the higher antitumor activity of CS-682 relative to CNDAC. In both CNDAC- and CS-682-treated carcinoma cells, CNDAC 5'-triphosphate (CNDACTP) was generated and incorporated into a DNA strand. High performance liquid chromatography (HPLC) and mass spectrometric analysis of the nucleosides prepared by digestion of the DNA from the CNDAC-treated cells detected ddCNC (2'-C-cyano-2',3'-didehydro-2',3'-dideoxycytidine), which was shown to be generated only when the self-strand-breakage of CNDACTP-incorporated DNA occurred. The cytotoxicity of CNDAC was completely abrogated by the addition of 2'-deoxycytidine and was low against cells with decreased deoxycytidine kinase. Our results suggest that CNDAC is converted to CNDACMP by deoxycytidine kinase and that the resulting CNDACTP incorporated into a DNA strand as CNDACMP may induce DNA-self-strand-breakage. This novel DNA-self-strand-breaking mechanism may contribute to the potent antitumor activity of CS-682. Int. J. Cancer 82:226–236, 1999. © 1999 Wiley-Liss, Inc.

Abstract: This study was conducted to investigate the correlation of thoracoscopic lung volume reduction to changes in pulmonary function and exercise performance in patients with pulmonary emphysema. Unilateral thoracoscopic lung volume reduction treatment was performed in 30 patients with severe pulmonary emphysema. If large bullae were present, they were excised using an endoscopic stapling device, and the emphysematous pleura was contracted by neodymium:yttrium-aluminium-garnet laser to reduce the volume of nonfunctional lung air space. Pulmonary function and incremental exercise tests were performed before and at least 3 months after treatment. Follow-up functional evaluation showed a highly significant improvement in the forced expiratory volume in 1s (FEV1), forced vital capacity, static compliance, and maximal oxygen uptake. The functional residual capacity as measured by the gas dilution method (FRCgas), was unchanged; however, it was found to be decreased significantly when measured by body plethysmograph (FRCbox). Positive correlations existed between the reduction in FRCbox and the increase in FEV1 (r=0.586,P=0.0042) and maximal oxygen uptake (r=0.550,P=0.018). Pulmonary ventilation and exercise ability in patients with pulmonary emphysema were improved in a volume-dependent manner by thoracoscopic lung volume reduction. These findings indicate that patients with a preoperative trapped gas volume level exceeding 11 would be ideal candidates for thoracoscopic lung volume reduction.

The structure–activity relationship of HIV-1 protease (HIV-1 PR) inhibitors containing α-hydroxy-β-amino acids is discussed. We demonstrated that substituent groups on the P1aromatic rings of the inhibitors exert significant influence on their biological activity. Inhibitors bearing an alkyl or a fluorine atom at the metaand paraposition on their P1benzene ring were found to be good inhibitors. We also discovered that the substitution positions of the P2benzamides were crucial for good antiviral potency. In this study, inhibitor 48was the most potent {IC90(CEM/HIV-1 IIIB) 27 nM} and showed good pharmacokinetics in rats.

A competitive enzyme-linked immunosorbent assay (ELISA) was developed for determination of CS-518, a novel thromboxane synthetase inhibitor. Antisera against CS-518 were obtained from rabbits immunized with bovine serum albumin linked to CS-518 via carboxylic acid introduced into the imidazolyl ring (for ELISA-1) or via 6-carboxylic acid directly (for ELISA-2). Each of two CS-518 derivatives was conjugated to horseradish peroxidase by a N-succinimidyl ester method, and it was used as a labeled-antigen in homogeneous combination with antisera. In ELISA-1, CS-518 was detectable in a range of 5pg - 1ng, and all cross-reactivities with main metabolites were less than 5%, in contrast to high affinity to the taurine and glucuronic acid conjugates of CS-518 in ELISA-2. Validity of ELISA-1 was confirmed by a high-performance liquid chromatography and ELISA-1 enabled specific determination of CS-518 in plasma samples deproteinized by methanol. When ELISA-1 was applied to determine CS-518 in platelets after oral administration to rabbits, CS-518 uptake up to maximum capacity in platelets (4.2-5.4 × 10-6 M) and slow elimination of CS-518 from platelets (T1/2 = 36-41 hr) were observed independent of CS-518 doses. These results confirm that CS-518 binds to thromboxane synthetase in platelets with high affinity.

Abstract: The present study examined the effects of subtotal oesophagectomy through a right thoracal and abdominal approach, on the postoperative water-electrolyte metabolism and cardio-pulmonary function of patients with thoracic oesophageal carcinoma. The primary water balance, total sodium intake, urinary NAG index, free-water clearance (CH2O), oxygen diffusion function of the lungs to aerate blood (DLO2-Index), and α-human atrial natriuretic polypeptide (α-hANP) were measured perioperatively until the seventh day. Subjects were divided by age according to whether they were older or younger than 70 years into 2 groups. In both groups, no change was observed in the primary water balance, total sodium intake, urinary NAG index or CH2O. However, all of the patients in the older group exhibited significantly higher α-hANP values than those in the control group, and the DLO2-Index was also higher in the former subjects during the first 3 days following surgery. It may be concluded that α-hANP is a hormone of considerable importance as it is secreted in large amounts in response to increased stress on the cardio-pulmonary system and serves to normalize the water balance causing this extra load.

Only 56 cases of inflammatory pseudotumor of the liver have been reported in the world literature since its first documentation in 1953. We report herein the case of a 68-year-old man incidentally found to have a lesion in the right lobe of the liver which closely resembled a neoplasm on imaging studies. Thus, partial hepatic resection was performed and histological examination of the resected specimen revealed a diagnosis of inflammatory pseudotumor. Surgical resection is the preferred treatment for inflammatory pseudotumor of the liver, especially in patients for whom a definite histologic diagnosis cannot be made preoperatively or by intraoperative frozen sections. In fact, most of the patients reported in the literature recovered uneventfully after local resection without any postoperative complications, as did our patient.

A sensitive and reliable analytical method for determining furosine in hair has been developed using liquid chromatography–tandem mass spectrometry. Fructose‐Nα‐formyl‐d4‐DL‐lysine was synthesized and used as an internal standard. By the present method, glycated lysine levels in hair could be determined as fructose‐lysine in only 0.1 mg of hair sample, ranging from 35.1–72.6 ng/mg hair among five healthy volunteers, which corresponded to 0.0635–0.153% of the total lysine contents in hair determined by amino acid analysis. © 1997 by John Wiley & Sons, Ltd.

A sensitive and reliable analytical method for determining furosine in hair has been developed using liquid chromatography–tandem mass spectrometry. Fructose-N^α-formyl-d4-DL-lysine was synthesized and used as an internal standard. By the present method, glycated lysine levels in hair could be determined as fructose-lysine in only 0.1 mg of hair sample, ranging from 35.1–72.6 ng/mg hair among five healthy volunteers, which corresponded to 0.0635–0.153% of the total lysine contents in hair determined by amino acid analysis. © 1997 by John Wiley & Sons, Ltd.

End stage renal disease (ESRD) patients may display the deficiency in vegetable-derived micronutrient, such as vitamins and minerals, due to the potassium-restricted diet. VCRESC, a drink type micronutrient supplement containing enough amounts of daily-required vitamins, is prescribed for patients with micronutrient deficiency in Japan.