A case of extra-adrenal pheochromocytoma with frostbite in extremities]

We describe a patient who presented frostbite in extremities in addition to characteristic symptoms, such as severe hypertension, sweating attacks, palpitations and headache. The patient was eventually diagnosed as having single extra-adrenal pheochromocytoma. The frostbite in extremities rapidly resolved after the removal of the tumor as well as other characteristic clinical symptoms. It is speculated that this frostbite might have been induced by severe continuous constriction of peripheral artery and loss of heat by frequent sweating attacks. Regarding cutaneous symptoms in this disease, pallor, acrocyanosis and cold extremities are commonly found. However, it seems that typical frostbite associated with pheochromocytoma has not been reported so far.     

Clinical studies on tosufloxacin (TFLX) in urology]

We clinically evaluated the usefulness of a new oral antimicrobial agent, TFLX, in the field of urology. The dose administered was 150 mg t.i.d and the duration of administration was 3 days. The clinical effect was evaluated according to the criteria of the Japanese UTI committee. The clinical response obtained on 164 female patients with acute simple cystitis was excellent in 118, moderate in 44 and poor in 2 patients. The efficacy rate was 98.78%. The clinical response obtained on 4 male patients with acute simple cystitis was excellent in 2 and moderate in 2 patients. The efficacy rate was 100%. The clinical response obtained on 3 female patients with simple pyelonephritis was excellent in 2 and moderate in 1 patient. The efficacy rate was 100%. The clinical response obtained on one patient with non-gonococcal urethritis was excellent by doctor's evaluation. The clinical response obtained on 7 patients with complicated UTI was excellent in 3 and moderate in 4 patients. The efficacy rate was 100%. Three patients complained of stomach distress or malaise and 2 patients developed rash. No abnormal laboratory data were observed. Thus, TFLX appears to be safe and suitable for use in the field of urology.     

Identification of an equivalent to murine Thy-1+ dendritic epidermal cells in the rat epidermis.

In the murine epidermis, there exist Thy-1+ dendritic epidermal cells (Thy-1+DEC). These cells are Thy-1+, CD45+, CD3+ and asialo GM1+ but CD5-, CD4-, CD8-, or Ia-1-, and express T cell receptor (TCR) gamma delta. Recently, most of these TCR gamma delta of Thy-1 DEC are shown to consist of a V gamma 3-V delta 1 combination. There has been no evidence that the same type of cell population exists in other species except mice. In this study, we investigated the existence of a Thy-1+DEC equivalent in the rat epidermis. The epidermal sheets obtained from rats were stained with various monoclonal antibodies to rat lymphocytes. We developed a monoclonal antibody (1F4) to rat CD3 complex. 1F4 stained thymocytes and peripheral T cells and also immunoprecipitated T cell receptor with CD3 complex. Using 1F4 and a recently developed monoclonal antibody to rat TCR alpha beta, we could identify dendritic CD4-, CD8-, CD5-, CD3+, TCR alpha beta- cells in the rat epidermis. These CD3+, TCR alpha beta- cells are strong candidates as an equivalent to TCR gamma delta + murine Thy-1+ DEC.     

High Human IgG Levels in Severe Combined Immunodeficient Mouse Reconstituted with Human Splenic Tissues from Patients with Gastric Cancer

We implanted normal peripheral blood lymphocytes (PBL) from healthy donors and splenic tissues from patients with gastric cancers into the severe combined immunodeficient (SCID) mouse, demonstrating that SCID mouse with splenic tissue can produce a high level of human immuno-globulin G (IgG). The normal PBLs at 10⁷ and 10⁸/mouse were implanted intraperitoneally, and three splenic tissues with a size of 3×3×3 mm from gastric cancer patients were inoculated subcutaneously into the bilateral backs of the mice. At 2, 4, 6 and 8 weeks after inoculation, mice were killed, and the human IgG was assessed by an ELISA method. SCID mice with splenic tissue revealed high human IgG levels from 2 weeks after inoculation and approximately 2 mg of IgG per ml was observed at 8 weeks post-implantation, while the IgG levels in mice treated with PBLs were limited. Since the half life of the extrinsic human IgG was 10.2 days, the high level of human IgG in the SCID mice was supposed to be produced by human plasma cells in the splenic tissue from gastric cancer patients. This model was thought to be adequate for evaluating human immunological functions in vivo.     

Signal-averaged body surface mapping for the assessment of low-amplitude potentials. Relation between ventricular depolarization and repolarization in normal subjects

To examine the relation between ventricular depolarization and repolarization, body surface isopotential maps at the end of the QRS complex were studied in 32 normal subjects using a signal-averaged body surface mapping system. The number of beats averaged was 96-154 (mean 126.2). In this study, there were 8 types of isopotential map patterns at the end of the QRS complex. Mean +/- SD of QRS duration, appearance time of repolarization, and disappearance time of depolarization were 82.0 +/- 8.7 msec, 71.8 +/- 10.5 msec, and 79.7 +/- 9.4 msec, respectively. Time duration of overlapping depolarization and repolarization was 8.6 +/- 6.4 msec. The early repolarization was widely distributed on the left anterior chest and the upper sternal region. These results demonstrated the difference between the appearance time of repolarization and the disappearance time of depolarization for each lead. We concluded that it is difficult to evaluate ECG waves in the terminal portion of the QRS complex with the dipolar theory only.     

Angiographic features of anoxic encephalopathy in the acute phase: a case report]

We present an angiographic feature of anoxic encephalopathy in the acute phase. A 68-year-old woman suddenly presented with deep coma. Examinations of her blood and electrocardiography did not reveal the origin of consciousness disturbance, and computed tomographic (CT) scans demonstrated no significant findings. We immediately performed cerebral angiography because we suspected brain stem infarction. A 3-vessel study (bilateral carotid and left vertebral angiography) revealed remarkable delays in cerebral circulation time or arteriovenous circulation time, although it did not show occlusion of cerebral vessels. The follow-up brain magnetic resonance (MR) images revealed anoxic encephalopathy, which might be derived from transient cardiac arrest. The patient has been in a vegetative state for one year. Although many reports have described CT scans and MR images of anoxic encephalopathy in the acute or subacute phases, there have been no reports about the angiographic features. We found remarkable delays in cerebral circulation time in the acute phase of anoxic encephalopathy, which was considered to be caused by cytotoxic edema from severe hypoxia or ischemia.     

Increased drug resistance of cultured human cancer cell lines in three-dimensional cellular growth assay using collagen gel matrix.

We have conducted a three-dimensional cellular growth assay using collagen gel matrix with an endpoint of the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H tetrazolium bromide (MTT) assay, on four human gastric and colonic cancer cell lines. Three-dimensionally growing cells in collagen gel matrix were 2- to 180-fold more resistant to mitomycin C, doxorubicin, 5-fluorouracil, and cisplatin than those in monolayer culture, and these resistances were increased further when the cells increased their three-dimensionality. Furthermore, the influence of fibroblasts in the collagen gel matrix on the chemosensitivity of cancer cells was less than that in monolayer culture. Since this new assay using collagen gel matrix with an endpoint of the MTT assay was able to detect the increase of drug resistance of human cancer cell lines by three-dimensional cellular growth using a simple and convenient procedure, it was considered to be more useful than conventional monolayer cultures for evaluating the chemosensitivity of cancer cells.     

Intracranial vertebral artery dissection in Wallenberg syndrome.

PURPOSETo assess the prevalence of vertebral artery dissection in Wallenberg syndrome.METHODSSixteen patients (12 men, 4 women; mean age at ictus, 51.6 years) with symptoms of Wallenberg syndrome and an infarction demonstrated in the lateral medulla on MR were reviewed retrospectively. The study items were as follows: (a) headache as clinical signs, in particular, occipitalgia and/or posterior neck pain at ictus; (b) MR findings, such as intramural hematoma on T1-weighted images, intimal flap on T2-weighted images, and double lumen on three-dimensional spoiled gradient-recalled acquisition in a steady state with gadopentetate dimeglumine; (c) direct angiographic findings of dissection, such as double lumen, intimal flap, and resolution of stenosis on follow-up angiography; and (d) indirect angiographic findings of dissection (such as string sign, pearl and string sign, tapered narrowing, etc). Patients were classified as definite dissection if they had reliable MR findings (ie, intramural hematoma, intimal flap, and enhancement of wall and septum) and/or direct angiographic findings; as probable dissection if they showed both headache and suspected findings (ie, double lumen on 3-D spoiled gradient-recalled acquisition in a steady state or indirect angiographic findings); and as suspected dissection in those with only headache or suspected findings.RESULTSSeven of 16 patients were classified as definite dissection, 3 as probable dissection, and 3 as suspected dissection. Four patients were considered to have bilateral vertebral artery dissection on the basis of MR findings.CONCLUSIONSVertebral artery dissection is an important cause of Wallenberg syndrome.     

Mental health in software engineers. I. Frequency of mental complaints, physical complaints and psychiatric disorders

This study examined the physical complaints, mental complaints and psychiatric disorders in software engineers. Subjects were 101 male software engineers. They were evaluated by a semistructured interview. Psychiatric diagnosis was based on DSM-III (Diagnostic and Statistical Manual of Mental Disorders, third edition). The results are summarized as follows: 1) Physical complaints were observed in 68% of the subjects with 25% of the subjects complaining of physical ill-health. This study showed that 12% of the subjects had hypertension, 12%, gastritis or gastro-duodenal ulcer, 14%, allergic disease, and 19% miscellaneous diseases. 2) Of the subjects 62% had mental complaints and 31% mental ill-health. Depressive symptom was the most frequent mental complaint with 32% of the subjects diagnosed as DSM-III. The common diagnoses were adjustment disorders (19%), major affective disorders (6%), psychological factors affecting physical condition (5%) and dysthymic disorder (3%). Only one subject sought professional help from a psychiatrist for relief of mental complaints. The data suggest the severity of mental ill health in software engineers, but methodological limitations preclude a firm conclusion at this time. Further studies should be made on the mental health state in software engineers.