Growing cavernous haemangioma of the liver: 11-fold increase in volume in a decade

A 57 year old Japanese male was incidentally found to have a 7.5 cm diameter hepatic haemangioma. Eleven years later he was operated on because the haemangioma had grown into a 17 cm mass causing upper abdominal fullness. Volumetry on computerized tomograms disclosed that the haemangioma had grown from 123 cm3 to 1343 cm3 in volume. Quantitative documentation on growing hepatic haemangioma has been rare.     

Japan''s share of research output in urology and nephrology

BACKGROUND: Recent studies have documented Japan's share of articles in different biomedical fields. However, Japan's contribution to urology and nephrology is not known. METHODS: Seven journals in this field with the highest impact factors were selected to obtain relevant data. In June 2002, we searched the Medline database to obtain country affiliation details of articles published in the selected journals during 1991-2000. The proportion of articles with a higher grade of evidence (randomized controlled trials or clinical trials, cohort studies and case-control studies) were also generated and compared to the average values for all articles published in these journals. RESULTS: Of the total number of articles (22 232), Japan's share of research output for the selected journals in urology and nephrology was 6% (1335 articles) and it ranked second in the world following the USA (56.5%). The recent increase in the share was statistically significant for Japan, Austria, France, Germany, Spain and Turkey. The proportion of articles with a high grade of evidence was lower for articles originated in Japan than for the total number of articles. CONCLUSION: Japan's contribution to urology and nephrology research is within the range of its contribution to other biomedical fields. However, the number of high quality clinical research conducted in Japan in this field was small.     

Electrophysiologic Determinants of Ventricuiar Rate in Human Atrial Fibriliation

Ventricular Rate During AF. Introduction: The mechanisms of the ventricular response during atrial fibrillation (AF) remain uncertain. The parameters obtained during an electrophysiologic study, including atrial rates during AF, were analyzed to clarify further the determinants of the ventricular rate during AF.
Methods and Results: Thirty patients without manifest preexcitation in whom AF was induced during electrophysiologic study were divided into two groups, Group I consisted of 20 patients (ages 55 ± 10 years) without a dual AV nodal pathway. Group 2 consisted of 10 patients (ages 53 ± 13 years) having a dual AV nodal pathway. The correlation coefficient between the mean RR interval during AF (mRR) and the mean intra-atrial potential interval during AF (mff) was positive (0.05 [P < 0.05] in group 1 and 0.37 [P = NS] in group 2). The correlation coefficient of the mRR against the functional refractory periods of the AV node (AVFRP) was 0.73 (P < 0.001) in group 1. The correlation coefficients between mRR and the fast AV nodal pathway functional refractory periods and the slow AV nodal pathway effective refractory periods (SPERP) were 0.58 (P = NS) and 0.7 (P < 0.05) in group 2, respectively. The correlation coefficients between mRR against (mff × AVFRP)^1/2 in group 1 and (mff × SPERP)^1/2 in group 2 were 0.8 (P < 0.001) and 0.72 (P < 0.05), respectively.
Conclusions: This clinical study did not indicate an inverse relation between the atrial and ventricular rates that had been reported by the previous experimental study. The ventricular rate during AF appeared to be quantitatively related to the atrial rate via AV node function. The importance of the slow pathway in determining the ventricular rate during AF was observed.     

Medical Management of Functioning Pituitary Adenoma: An Update

The treatment of functioning pituitary adenoma (FPA) must achieve endocrinological remission as well as tumor size reduction. The first-line treatment of FPA except prolactinoma is transsphenoidal surgery (TSS). Medical treatments and/or radiation will be applied as adjuvant therapies succeeding to TSS. In patients with prolactinoma, dopamine agonists, especially cabergoline, are quite efficient. Dopamine agonists decrease plasma prolactin levels and induce shrinkage in most patients and can be ceased in some of them. In patients with acromegaly, dopamine agonists, somatostatin analogues, and growth hormone receptor antagonist have been used as a monotherapy or the combination, and the high remission rate can be achieved. Pasireotide having high affinity to type 5 somatostatin receptors will be available for the patients presenting resistance against type 2 receptor agonists, such as octreotide and lanreotide. The preceding treatment with somatostatin analogues is beneficial for improving the success rate of TSS. The chimera compounds of somatostatin analogues and dopamine agonists have been investigated. The medical treatments of Cushing''s disease are challenging, if TSS is not successful. To suppress ACTH secretion, dopamine agonists and somatostatin analogues have been examined, but neither came to show a sufficient effect. Pasireotide reduces urinary cortisol excretion with a high remission rate. Adrenal enzyme inhibitors (AEIs), such as metyrapone, can inhibit cortisol synthesis form adrenal glands promptly and sufficiently in most of patients. LCI699, a newly developed AEI, is more potent than metyrapone and will be available. We should use available medical treatments for improving the prognosis and quality of life.     

A comparative study of nucleolar organizer region, proliferating cell nuclear antigen and epidermal growth factor receptor staining in colon tumours

Several studies have reported that proliferating cell nuclear antigen (PCNA), nucleolar organizer regions (NOR) and epidermal growth factor receptor (EGF-R) are cellular proliferation parameters in malignant tumours. However, the correlation of EGF-R with PCNA and NOR has not been reported in colon tumours. To clarify this, we investigated the correlation of the expression of EGF-R with PCNA and NOR in colonic epithelial tumours. Using immunohistochemical staining and one-step silver staining techniques, the expressions of EGF-R-, PCNA- and NOR-associated protein were studied in paraffin sections from five normal mucosae, 10 adenomas with mild atypia, 16 adenomas with moderate atypia, 32 adenomas with severe atypia including carcinoma in situ and 47 with invasive colon carcinomas. Significant differences were found among the respective degrees of atypia in Ag-NOR counts, PCNA labelling index (LI), and the expression of EGF-R. However, there were no significant differences among the Ag-NOR counts of the severe atypia and invasive carcinoma. There was a significant positive correlation between Ag-NOR counts and PCNA LI (P<0.001). The Ag-NOR counts and PCNA LI in EGF-R-positive cases were higher than in EGF-R-negative cases (P<0.001). These results indicate that each of the parameters increased significantly with the increase in atypia and the progression of cancer. Epidermal growth factor receptor provokes an exacerbation of protein synthesis and the cell cycle in colonic epithelial tumours.     

Concurrent pityriasis rotunda and acquired ichthyosis with IgG myeloma

A case of concurrent pityriasis rotunda and acquired ichthyosis associated with IgG-myeloma is described.     

Chondrodysplasia Punctata with Myopathic Involvement

Abstract Histopathological examination of the muscle and the iliac crest cartilage were performed in a one year 6-month-old girl with chondrodysplasia punctata. The patient's mother was also affected.
Light micrographs of the cartilage revealed long, tongue-like processes extending into the osseous tissue in the osteochondral junction. Electron micrographs of the cartilage showed an increased number of lipid droplets in chondrocytes and more numerous hydroxyapatite clusters and matrix vesicles in the inter-territorial matrix. Pathological findings of the biopsied muscle included derangement and/or missing cross-striations, together with many vacuoles in the muscle fibers. These degenerative changes in both the muscle and the cartilage as well as many associated complications may suggest that chondrodysplasia punctata is a generalized metabolic disorder.     

Clinical Application of Left Ventricular Assist Devices

In Japan, 32 patients have had application of monoventricular and biventricular assist devices during the past three years. Five of the 32 patients treated by the Fall of 1986 have successfully achieved long-term survival. In this paper we describe our experience with the Tomasu and Pierce VAD in a total of four and two patients, respectively. Four of the six patients could be successfully weaned from the VAD and two of them were long-term survivors. Nonsynchronizing pumping of the VADs was effective, as well as synchronizing pumping. Anticoagulant therapy is highly recommended during the use of the VAD although there was no significant incidence of thromboembolism or thrombus in the devices in this clinical series.     

Properties of the binding sites of [3H]9-methyl-7-bromoeudistomin D in bovine aortic smooth muscle microsomes

Abstract— [³H]9-Methyl-7-bromoeudistomin D ([³H]MBED), a powerful caffeine-like Ca²⁺ releaser, binds to the caffeine binding site of terminal cisternae of skeletal muscle sarcoplasmic reticulum and activates Ca²⁺-induced Ca²⁺ release. Properties of the binding site of [³H]MBED were investigated in aortic smooth muscle. The specific activity was higher in microsomes than in other fractions. [³H]MBED binding sites in smooth muscle microsomes were of a single class with a high affinity (K_D 50 Nm ), comparable with that in skeletal muscle sarcoplasmic reticulum. Caffeine competitively inhibited [³H]MBED binding, indicating MBED shares the same binding site with caffeine. Solubilization and fractionation of the microsomes gave two fractions of [³H]MBED binding activities. These results suggest that, in smooth muscle, there are multiple binding sites of [³H]MBED and caffeine, which might correspond to different pharmacological actions of caffeine on smooth muscle. Therefore, [³H]MBED, which binds to the different binding sites of caffeine, is useful as a probe for investigation of the actions of caffeine at the molecular level.