Total parathyroidectomy improves survival of hemodialysis patients with secondary hyperparathyroidism

Background and aims: To compare the prognosis of chronic hemodialysis patients with or without parathyroidectomy. Methods: Among 158 chronic hemodialysis patients who underwent total parathyroidectomy between July 1998 and April 2009, 88 patients were matched with 88 controls for sex, age, underlying disease and prior dialysis history. Then a retrospective evaluation of their prognosis was performed over a median observation period of 4.41 years. Results: The overall survival rate was 90.4% in the parathyroidectomy group and 67.4% in the control group. The cardiovascular death-free survival rate was 94.6% in the parathyroidectomy group and 76.3% in the control group. During observation, intact parathyroid hormone was measured every 6 months, and its average serum level was 37 ± 92 ng/L in the total parathyroidectomy group versus 274 ± 233 ng/L in the control group (p=0.0001). The total parathyroidectomy group had a significantly lower corrected calcium level and higher serum albumin level. Multivariate analysis revealed that parathyroidectomy, atrial fibrillation and serum albumin were significant factors for both total and cardiovascular mortality. Conclusion: Total parathyroidectomy was associated with better survival, probably due to decreased cardiovascular mortality.     

Large goiter and multiple rib tumors

We report an interesting case of a 47-yr-old who had a large goiter and multiple rib tumors. The patient was initially suspected of having thyroid cancer, which had metastasized on the ribs, based on imaging studies. However, laboratory tests revealed a high level of ionized calcium and parathyroid hormone (PTH). The large goiter was diagnosed as having parathyroid tumors owing to the high level of PTH in the tissue fluid. The biopsy specimen from a rib tumor was diagnosed as containing brown tumors associated with primary hyperparathyroidism (PHP). The patient also had prolactinoma and pancreatic gastrinoma. Her daughter had both prolactinoma and PHP, and her brother and her father had PHP. Thus, the patient was diagnosed as having multiple endocrine neoplasia type 1.     

Intravascular large B cell lymphoma with migratory local high density shadow by chest CT and diagnosed by transbronchial lung biopsy

The intravascular large B cell lymphoma (IVL) is a rare subtype characterized by the presence of lymphoma cells in the lumina of small vessels. Reported here is the case of a 68-year-old woman with a high-grade fever uncontrolled by antibiotics or antipyretic drugs, and elevation of the serum LDH and sIL-2R levels. After she was admitted, dyspnea, hypoxia, and severe body weight gain with leg edema gradually developed. Chest computed tomography (CT) revealed a characteristic migratory local high density area typical of atelectasis. A diagnosis of IVL was made with a transbronchial lung biopsy (TBLB) and immunohistochemical analysis. The patient was treated with combination chemotherapy (modified CHOP), and her symptoms of dyspnea, hypoxia, pyrexia and leg edema were quickly resolved. The level of LDH and sIL-2R returned to normal, and a complete response was obtained. Although diagnosis of IVL is difficult, an early and appropriate diagnostic procedure (biopsy of tissue with vessels, such as lung and skin, is required) will improve the prognosis of IVL.     

Critical value for the index of body fat distribution based on waist and hip circumferences and stature in obese girls

OBJECTIVE: To determine the critical value for the standard deviation score (SDS) of waist-hip ratio (WHR)/height (Ht), as an age-adjusted measure of body fat distribution, in relation to occurrence of biochemical complications in obese girls. DESIGN: Cross-sectional, clinical study. The (WHR/Ht)-SDS was calculated as described previously. Obese girls were classified into two groups according to the occurrence of abnormal values in either serum triglyceride, alanine aminotransferase or insulin level. The criteria for obesity were subjected to the receiver operating characteristic (ROC) analysis. SUBJECTS: One-hundred and twenty-four outpatient Japanese obese girls, ranging in age from 9 to 15 y. MEASUREMENTS: Height, body weight, waist girth and hip girth as anthropometric measures. Percentage overweight, waist girth, WHR and (WHR/Ht)-SDS as criteria for obesity. Clinical laboratory analysis for fasting blood samples of obese children. RESULTS: Fifty-nine girls were classified into the no complication group, and 65 girls into the complication group. Those with complications were older, more obese, and their waist girth and WHR were larger, than the girls without complications. The (WHR/Ht)-SDS was >2-fold higher and lipoprotein profile was more atherogenic in the complication group than in the no complication group. Among the four criteria of obesity, (WHR/Ht)-SDS gave the ROC curve skewed furthest into the top left corner of the diagram. Both sensitivity and specificity for (WHR/Ht)-SDS were >80% at the critical value of 2.00. The sensitivity for waist girth was as high as that for specificity for the rest of the criteria were <80%. CONCLUSION: Only (WHR/Ht)-SDS showed high enough sensitivity and specificity to predict metabolic derangement in the present obese girls. (WHR/Ht)-SDS can serve as the diagnostic criterion that classifies obesity in Japanese adolescent girls into two types.     

Carboxyl-terminal deletion and point mutations decrease the transforming potential of the activated rat neu oncogene product.

The rat neu oncogene encodes a constitutively activated growth factor receptor/transmembrane tyrosine kinase, p185Tneu, that is structurally similar to yet distinct from the epidermal growth factor receptor. To explore the role of the carboxyl-terminal region and of putative autophosphorylation sites in regulating the activity of the rat p185Tneu (T, transforming) protein, we used site-directed mutagenesis to generate a p185Tneu mutant in which a putative tyrosine autophosphorylation site (residue 1253) at the extreme carboxyl terminus was replaced by a phenylalanine residue and a mutant in which the carboxyl-terminal 122 amino acids were deleted. These proteins were expressed in NIH 3T3 cells at comparable levels and exhibited similar autophosphorylation activity, exogenous substrate phosphorylation ability, oligomerization levels, and responsiveness to a partially purified neu-activating factor. However, the mutant p185Tneu proteins displayed a decreased transforming capacity both in vitro and in vivo. This analysis demonstrated that the carboxyl-terminal domain and at least one putative tyrosine autophosphorylation site of p185Tneu play a role in positively regulating the cell growth-regulating properties of the neu protein.     

Simulation of Granular Flows and Pile Formation in a Flat-Bottomed Hopper and Bin,and Experimental Verification

Granular flows of 200 μm particles and the pile formation in a flat-bottomed hopper and bin in the presence of air and in a vacuum were predicted based on three-dimensional numerically empirical constitutive relations using Smoothed Particle Hydrodynamics and Computational Fluid Dynamics methods. The constitutive relations for the strain rate independent stress have been obtained as the functions of the Almansi strain including the large deformation by the same method as Yuu et al. [1]. The constitutive relations cover the elastic and the plastic regions including the flow state and represent the friction mechanism of granular material. We considered the effect of air on the granular flow and pile by the two-way coupling method. The granular flow patterns, the shapes of piles and the granular flow rates in the evolution are compared with experimental data measured under the same conditions. There was good agreement between these results, which suggests that the constitutive relations and the simulation method would be applicable for predicting granular flows and pile formation with complex geometry including free surface geometry. We describe the mechanisms by which the air decreases the granular flow rate and forms the convergence granular flow below the hopper outlet.