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To identify the magnetic resonance imaging (MRI) features of metastases to the extraocular muscles (EOM metastases).The MRI features of 19 patients with EOM metastases were compared with those of 24 patients with EOM diseases of non-thyroid origin. MRI was used to assess the number of tumours, morphology, signal intensity on T2-weighted images, enhancement patterns, and apparent diffusion coefficient (ADC) values.Single muscular involvement was observed in 10 patients, and multiple muscular involvement was observed in nine patients. The morphology was focally discrete in nine patients, and diffuse infiltrative in 10 patients; all the nine patients with focal discrete morphology presented with single muscular lesions. On T2-weighted images, the signal intensities were intermediate or low in 15 patients and a mixture of high and intermediate in four patients. In 14 patients for whom contrast-enhanced images were available, ring enhancement (n=5), heterogeneous diffuse enhancement (n=5), and homogeneous enhancement (n=4) were seen. The mean ADC value was 0.98 × 10The MRI features of EOM metastases showed two main patterns: a single discrete mass and multiple infiltrative masses. In addition to the presentation as a single discrete mass, the presence of hyperintensity on T2-weighted images and ring or heterogeneous enhancement can aid in the differentiation of EOM metastases from other EOM diseases.

Aim The aim of this study was to investigate the effects of ezetimibe on high-density lipoprotein (HDL) subspecies and serum amyloid A (SAA), an apolipoprotein mainly bound and transported by HDL particles, in patients with end-stage renal disease (ERSD), a condition typically characterized by high SAA- and low HDL-cholesterol (C ) levels. Methods 26 ERSD patients receiving hemodialysis (HD) were given ezetimibe (10 mg/d) for 6 - 8 weeks. HDL3 was separated from serum by a single precipitation method established by our group. HDL2 was estimated by subtracting HDL3 from total HDL. Serum amyloid A (SAA) was measured by the ELISA method. Results Ezetimibe significantly reduced remnant-like particle (RLP)-C, low-density lipoprotein (LDL)-C, and apolipoprotein (apo) B without affecting triglyceride, HDL-C and LCAT activities. HDL2-C levels were lower and HDL3-C was substantially lower in the HD patients than in the controls. Ezetimibe increased HDL2-apoAI but decreased HDL3-apoAI without affecting serum apoAI or AII. HDL-SAA was 5-fold higher in the HD patients than in the controls (56 ± 49 vs. 12 ± 9 µg/ml). Ezetimibe decreased HDL-SAA by 43 % (to 32 ± 36 µg/ml), and this inhibitory effect was exclusively attributable to a 72% reduction in HDL3-SAA in response to the ezetimibe treatment. The reduction of HDL3-SAA was significantly associated with increased HDL2-apo AI and reduced HDL3-apo AI. Conclusions Ezetimibe treatment decreased "inflammatory" (SAA-containing) HDL3, and may thus have restored the anti-atherogenic function of HDL particles in ESRD patients.

A nicotine part-filter method can be applied to estimate smokers' mouth level exposure (MLE) to smoke constituents. The objectives of this study were (1) to generate calibration curves for 47 smoke constituents, (2) to estimate MLE to selected smoke constituents using Japanese smokers of commercially available cigarettes covering a wide range of International Organization for Standardization tar yields (1-21mg/cigarette), and (3) to investigate relationships between MLE estimates and various machine-smoking yields. Five cigarette brands were machine-smoked under 7 different smoking regimes and smoke constituents and nicotine content in part-filters were measured. Calibration curves were then generated. Spent cigarette filters were collected from a target of 50 smokers for each of the 15 brands and a total of 780 filters were obtained. Nicotine content in part-filters was then measured and MLE to each smoke constituent was estimated. Strong correlations were identified between nicotine content in part-filters and 41 out of the 47 smoke constituent yields. Estimates of MLE to acetaldehyde, acrolein, 1,3-butadiene, benzene, benzo[a]pyrene, carbon monoxide, and tar showed significant negative correlations with corresponding constituent yields per mg nicotine under the Health Canada Intense smoking regime, whereas significant positive correlations were observed for N-nitrosonornicotine and (4-methylnitrosoamino)-1-(3-pyridyl)-1-butanone.

A 67-year-old female was admitted to our hospital with eruption and cervical lymphadenopathy which occurred one week after pneumococcal vaccination. Polyclonal hyperimmunoglobulinemia (IgG 6,620 mg/dl) and mild plasma cell proliferation (6.4%) in a bone marrow specimen were found, but a lymph node aspiration biopsy showed no specific findings. Normochromic and normocytic anemia with a positive direct Coombs test were also confirmed. Short-term intensive steroid therapy was given, but the systemic eruption and lymphadenopathy continued. About 4 months after vaccination, she suffered from edema in her face and legs and visual disturbance. When massive proteinuria (10.4 g/day) was found, she was admitted to our ward. A renal biopsy specimen showed a minor glomerular abnormality with mild interstitial plasmacytic infiltration. An abdominal CT scan showed hepatosplenomegaly and para-aortic lymphadenopathy. Uveitis was also found by ophthalmoscopy. These abnormalities completely disappeared after intensive steroid therapy including pulse therapy. On the basis of her clinical course and laboratory findings, it was suggested that minimal change nephrotic syndrome might be induced after vaccination, possibly due to hypersensitivity syndrome.

There are indications that advanced glycosylation end-products (AGEs) may affect in some manner the functions of the peritoneum. Only a few reports discuss the actual generation of glycosylated proteins and the intraperitoneal kinetics involved during continuous ambulatory peritoneal dialysis (CAPD). To demonstrate the formation of AGEs and their time-courses in peritoneal dialysis (PD) effluents, measurements were made of furosine, carboxymethyl lysine (CML), and pentosidine as glycosylation markers in vitro and in vivo using PD effluents obtained every 2 hours for up to 8 hours from 3 nondiabetic CAPD patients. Furosine and CML were found to be generated relatively early (within 6 hours), and their de novo formation was markedly enhanced subsequent to glucose addition. Furosine and CML production increased in proportion to glucose concentration. Pentosidine production did not change with time for up to 24 hours, and was not induced by glucose during this period. Carboxymethyl lysine production appeared to be suppressed in vitro with the addition of serum protein. Furosine in the intraperitoneal dialysate was initially the same as that in the plasma, but increased to twice as much in just 2 hours in vivo. Production of CML increased, but apparently was suppressed with leakage of plasma protein into the dialysate; this possibly may have been due to dilutional or antiglycation effects in the plasma. No stimulation of pentosidine production could be detected in the intraperitoneal dialysate even at 8 hours. The initiation of glycosylation of peritoneal proteins, with generation of furosine and CML but not pentosidine, is clearly shown by the present results to occur relatively early in the intraperitoneal dialysate, i.e., within a matter of hours.

Objective, fast and easy methods have not been established in the examination of urine sediment to differentiate between glomerular and nonglomerular hematuria. In this study, we used a newly developed automated urinary flow cytometer that can clearly recognize red blood cells (RBC), white blood cells, epithelial cells, bacteria and crystals by their size and fluorescence intensity without sedimentation. 98 urine samples from 31 glomerular and 67 nonglomerular lesions were analyzed by the device, and the criteria to determine the origin of hematuria were established based on the results. Additional 108 cases were tested to evaluate the validity of these criteria. According to the analysis of histograms of urinary RBC size distribution, cases in whom/=80% of all RBC have forward scatter (FSC) intensities/=126 and80% of all RBC have FSC intensities/=84 were regarded as representing the glomerular type. Cases in whom/=80% of all RBC have intensities FCS/=84 and80% all RBC have FSC intensities/=126 were regarded as representing the nonglomerular type. Cases in whom80% of all RBC have FSC intensities/=126 and80% of all RBC have FCS intensities/=84 were regarded as the mixed type. Cases in whom/=80% of all RBC have FSC intensities/=126 and/=80% of all RBC have FSC intensities/=84 were regarded as the nonglomerular type. The sensitivity for glomerular RBC in the first 98 cases was 90.3% and the specificity 92.5%, and in the second 108 cases the values were 100 and 86.6%, respectively. The automated urinary flow cytometer is useful as a means for routine differential diagnosis of hematuria, and at least it is promising as the screening test for differentiation between glomerular and nonglomerular hematuria, because it can examine numerous samples within a short time and does not necessitate any special skill or knowledge.

An 84-year-old woman was admitted to Ehime University hospital because of fever and generalized swelling of lymph nodes. On admission, she did not have any bone diseases. The laboratory data included a WBC count of 60,900/microliter, with 80.5% atypical plasma cells in the peripheral blood and 26.4% in the bone marrow. The patient's serum total protein was 9.3 g/dl with increased polyclonal gamma-globulin (62.4%). Serum levels of LDH (1,986 IU/l) and IL-6 (34.3 pg/dl) were also elevated. Immunofixation-electrophoresis detected a monoclonal band defined as IgA-lambda type, with a broad band of polyclonal immunoglobulin. Southern blotting analysis demonstrated rearranged monoclonal bands in the JH and J lambda genes. Based on these findings, plasma cell leukemia (IgA-lambda type) was diagnosed. The patient was treated with combination chemotherapy for acute lymphocytic leukemia and achieved complete remission. However, she died of aspergillus sepsis two months after admission. After chemotherapy, the patients IgG and IgM levels normalized but IgA still showed a slight increase. IL-6 also decreased, from 34.3 pg/dl to 10.2 pg/dl. To our knowledge, this report is the first in the literature concerning a case of plasma cell leukemia with polyclonal hypergammaglobulinemia.

Hyaluronan (HA) plays an important role in peritoneal tissue remodeling and the inflammatory process. In this study, attention was directed to the effects of various osmotic agents on HA synthesis in human peritoneal mesothelial cells (HMCs) and fibroblasts (HFBs). Following incubation with growth arrest media for 48 hours, the cells (4 x 10(4)/mL) were incubated for 72 hours in media at various concentrations (50, 100 mmol/L for crystalloid agents and 3.5%, 7% for oncotic agents) of glucose, mannitol, glycerol, sucrose, raffinose, NaCl, combined amino acids, maltodextrin, dextran 70, and hydroxyethylstarch 20. HA synthesis for 72 hours was measured by sandwich-binding protein assay. HMCs synthesized approximately 0.15 ng/cell/72 hours and HFBs 0.09 ng. All crystalloid osmotic agents significantly suppressed HA synthesis by HMCs and HFBs in a concentration-dependent manner. There was no such suppression by any oncotic osmotic agent, which, to the contrary, enhanced the synthesis by 6%-63% in HMCs. In conclusion, HMCs and HFBs may be considered sources of HA in the peritoneal dialysis effluent. Crystalloid osmotic agents suppressed HA synthesis in these cells. Oncotic osmotic agents seem to be less toxic in this regard.

During the past 15 years, we encountered 1051 facial fractures. The number of patients with facial fractures accounted for 0.76% of the over all outpatients at the ENT clinic of Osaka City University Hospital. There were 496 nasal bone fractures, 111 maxillary fractures, 167 zygomatic fractures, 122 mandibular fractures, and 130 orbital fractures. These types of fractures accounted for 47.2%, 10.6%, 15.9%, 11.6%, and 12.4% of the over or facial fractures, respectively. The ratio of men to women was nearly three to one, with 794 men and 257 women. Among nasal fractures, injury causes were ranked in the order of fighting, sports, and traffic accident. Among facial fractures, injury causes were ranked in the order of the traffic accident, fighting, and falling down.

We treated eight eyes of five patients with mycotic endophthalmitis. Intraocular inflammatory changes in one of these eyes improved only by antifungal therapy with 21-day administration of miconazole and fluconazole. The other seven eyes underwent vitrectomy, and the preoperative periods between the onset of ocular complications and the operation ranged from one and a half months to three months, during which time fungi were isolated only in one case. Dense vitreous opacities caused by the colonies of the fungi were found in the all vitrectomized eyes. Vitrectomy in the three cases showing no retinal detachment was effective for the improvement of either visual acuity or ophthalmoscopic findings, whereas vitrectomy was not effective in the other two cases with the occurrence of the pre-retinal membrane causing traction retinal detachment. The present investigations suggest that persistent endophthalmitis and the appearance of total retinal detachment made the improvement of retinal changes difficult because of the inflammatory and fibrotic processes between the retina and the vitreous body. It, therefore, is shown that anti-fungal therapy should be initiated when mycotic endophthalmitis is suspected, but in cases without response to the drug, vitrectomy should be performed before retinal detachment occurs.

Serum and tumor extracts from a patient with adrenocortical carcinoma and hypoglycemia were studied using conventional bioassay and radioreceptor assays. Immunoreactive insulin in all sera and extracts was low or undetectable. Increased insulin-like activity (about 2 × normal) was detected in the insulin radioreceptor assay and in the fat cell bioassay, suggesting the presence of some other insulin-like material in blood. An increased level of NSILA-s related peptides was even more prominent (4 × normal) when the more specific NSILA-s/MSA radioreceptor assay was employed. Delineation of the tumor as the probable source of the NSILA-s related peptides was highly dependent on studying the proper type of extract. Acetone-ethanol extracts of rumor were 4- to 20-fold more active in the NSILA-s/MSA receptor assay than unaffected tissues; these elevated levels of NSILA-s related peptides were confirmed by insulin radioreceptor assay and fat cell bioassay. Acid-ethanol extracts showed the same general pattern, bu...

A 57-year-old man was examined after head trauma and found to have long-lasting organic spasm of the near reflex lacking accommodative spasm. Convergence and miosis had been consistently observed for the follow-up period of one year and three months. Electrooculographical findings showed that there was no lateral rectus muscle palsy in either eye, and that his esotropia became intense in total darkness, compared with fixation on a visual target. Persistent convergence and miosis completely disappeared within 7 minutes after intravenous injections of benzodiazepine. Furthermore, he was able to make a normal near reflex when the spasm disappeared. The effect of benzodiazepine suggests that the disturbance of the GABAergic (gamma-aminobutyric acid) inhibitory system in the near reflex may be responsible for the occurrence of the spasm.

Utilizing an acid gel chromatography and insulin radioreceptor assay (RRA), serum levels of receptor assayable insulin-like activities were measured under various conditions. Acid gel filtration of sera on a Sephadex G-50 was adopted to separate small molecular ILAs from binding proteins before the assay by RRA. By employing 125I-pork insulin as the tracer, and pork insulin as the standard, an RRA for insulin was developed, in which kidneys of sacrificed pregnant guinea pigs were used as the source of the solubilized receptor. After gel-filtration of the sera, pooled fractions, which grossly corresponded to those of 125I-insulin marker, were assayed by RRA. The subjects consisted of fifty-nine cases: normal control subjects (n = 19), active acromegaly (6), Sheehan's syndrome (5), liver cirrhosis (7), chronic renal failure (10), non-insulin dependent diabetes mellitus (6), overt hyperthyroidism (5) and Nelson's syndrome (1). The average receptor assayable ILA of the normal control subjects was 40.2 +/- 12.2 ng/ml. As insulin RRA has a big interassay variation, receptor assayable ILA-ratio was used to minimize the variation, and each data was shown as the ratio to the average ILA of the normal controls. By this method, sera from normal adults had a mean (+/- SD) receptor assayable ILA ratio of 1.00 +/- 0.28. Four out of six cases of acromegaly revealed significantly high concentrations, and the average receptor assayable ILA-ratio of acromegaly was 1.30 +/- 0.28 (mean +/- SD, p less than 0.015). In the cases of Sheehan's syndrome, the ILA-ratio was 0.30 +/- 0.12, which was significantly low (p less than 0.001). Therefore, GH dependency was suspected from these two factors. However, the direct correlation was not indicated between GH and receptor assayable ILA. It was also considered that receptor assayable ILA was influenced not only by GH but also by some other factors. Furthermore, the subjects with liver cirrhosis indicated the low levels of receptor assayable ILA-ratio of 0.46 +/- 0.31, while the subjects with chronic renal failure showed the high ILA-ratio of 1.59 +/- 0.45 (p less than 0.05). No differences in ILA-ratio were found in the subjects with diabetes mellitus, hyperthyroidism and Nelson's syndrome, compared to the normal subjects.