Case of leiomyosarcoma of the renal pelvis

A 54-year-old man presented at the Mibayashi clinic with bowel discomfort. Ultrasonography showed a left renal mass and the patient was referred to Noto General Hospital for urological evaluation. Results of the physical examination were unremarkable, but computed tomography and magnetic resonance imaging demonstrated a large tumor in the middle of the left kidney. The patient underwent left nephrectomy. On hemisection of the kidney, a firm tumor, measuring 8 x 7.5 cm, was seen occupying the renal pelvis. The histological diagnosis was leiomyosarcoma arising from the right renal pelvis. No treatment was provided after surgery and no recurrence was observed 6 months postoperatively.     

Visceral fat accumulation as an important risk factor for obstructive sleep apnoea syndrome in obese subjects

Objectives. It is well known that obstructive sleep apnoea (OSA) is frequently associated with obesity. In the current study, we investigated the correlation between abdominal visceral fat accumulation and the presence of OSA in obese subjects.
Subjects. A consecutive series of 37 patients (17 men and 20 women) with primary obesity who were admitted to the Second Department of Internal Medicine, Osaka University Hospital, were investigated. Patients with OSA were designated as those whose apnoea index (number of apnoea h⁻¹ of sleep) was more than 5.
Main outcome measures. The distribution of body fat was determined using computed tomographic sections. The upper airway dimensions were evaluated with indices obtained by cephalometry in both inspiratory and expiratory phases.
Results. Visceral adipose tissue (AT) area which was measured at the level of the umbilicus, and its ratio to total AT area were both significantly greater in OSA patients as compared with those in non-OSA patients. All subjects whose visceral AT area measured more than 220 cm² manifested OSA. These two parameters also closely correlated with an increase in apnoea index. A multiple linear regression analysis revealed that the visceral AT area significantly correlated to apnoea index when age, AT mass and lean body mass were taken into account. The fluctuations of the upper airway were significantly greater in the large visceral fat group than in the small visceral fat group.
Conclusions. These results suggest that visceral fat accumulation is an important risk indicator for OSA in obese subjects.     

Megakaryocytic Maturation is Regulated by Maintaining a Balance Against Cytokine Induced-cell Proliferation: Steel Factor Retards Thrombopoietin-induced Megakaryocytic Differentiation While Synergistically Stimulating Mitogenesis; Hematopoiesis

Using a factor-dependent cell line MO7ER, which contains a stably transduced human erythropoietin (EPO) receptor gene in human megakaryoblastic cell line MO7e and which resulted in concomitant expression of EPO receptor, c-Mpl and c-Kit, we investigated the biological effects of these cytokines in terms of cell growth and differentiation. Thrombopoietin (TPO), EPO and Steel factor (SLF) all stimulated MO7ER cell proliferation in a dose-dependent manner. Combined stimulation of cells with SLF plus either TPO or EPO resulted in striking synergistic enhancement of MO7ER cell growth as compared with each cytokine alone, whereas combination of TPO plus EPO showed only an additive effect on cell proliferation. With regards to cell differentiation, either TPO or EPO treatment induced enhancement of platelet glycoprotein (GP) IIb/IIIa and GPIb expression. SLF induced GPIIb/IIIa and GPIb expression, but the effect was much weaker than that of EPO or TPO. However, addition of SLF to either TPO- or EPO- containing cultures (which induced potent mitogenesis in MO7ER cells) resulted in suppression of these megakaryocyte specific antigens. Addition of low-dose cytosine arabinoside (Ara-C)(1 to 10 ng/ml) enhanced TPO- or EPO- induced megakaryocytic differentiation in MO7ER cells while mildly suppressing cell growth. Treatment the cells with low-dose Ara-C plus TPO plus SLF overrode the proliferative enhancing effects of SLF and induced GPIIb/IIIa and GPIb expression as efficient as TPO alone. Retardation of TPO-induced megakaryocytic maturation was also observed in normal murine bone marrow cells by combined stimulation with TPO and SLF as assessed by the numbers of acetylcholinesterase staining-positive cells and megakaryocyte nuclear polyploidy. These results suggest that megakaryocytic maturation is, at least in part, regulated by countering cytokine-induced cell proliferation.     

Evaluation of the peripheral circulatory status of the neonate during homeothermal adjustment by plethysmo-time-interval

The plethysmo-time-interval (PTI) is the time interval between the beginning of the QRS complex on an ECG and the upstroke of the pulse wave on a plethysmogram, as measured by pulse oximetry. In the present study, we investigated homeothermal acclimatization to the extra-uterine environment in human neonates using the Coretemp thermometer and a pulse oximeter. Temperature was measured at three sites: the central deep temperature (CDT) on the upper sternum, the peripheral deep temperature (PDT) on the flat part of the left sole of the foot and the surface temperature (ST) at the side of the abdomen. After delivery, CDT and ST were higher than PDT. The difference between CDT and PDT was large at first, but gradually decreased. PDT, initially in the range of 32.4 ± 0.28°C, reached a stable value (34.4 ± 0.41 °C) at 2.5 h after delivery. PTI was prolonged in parallel with PDT. The difference between CDT and PDT probably reflected the contraction of skin vessels, particularly the arterioles, which occurs as a body defense mechanism against heat loss. As PTI was prolonged in parallel with PDT, we demonstrated objectively that this catch-up phenomenon of PDT after delivery was affected by the increase in skin blood flow as a result of dilatation of peripheral arterioles. It was concluded that PTI can be used to evaluate the peripheral circulatory status of the neonate, even during homeothermal adjustment after birth, by applying a new principle of pulse oximetry that is widely used in neonatal intensive care units.     

New Fetal Growth Curves for Japanese

ABSTRACT. New fetal growth curves for Japanese have been made with the cooperation of 37 major medical centers throughout Japan by the sponsorship of the Ministry of Health. They are reliable in regard to the adequacy of the sample number, the accuracy of the data on gestational age and the proper processes of composing growth curves. Effect of sex and parity are significant on weight but not on length and head circumference growth curves. The light-for-dates infant is defined as below mean -1.5 SD by the statistic analysis of their morbidity. These new official fetal growth curves will solve current confusion of several fetal growth curves from different institutions in Japan.     

Liaison psychiatry and HIV infection (II): Application of relaxation in HIV positive patients

Abstract We examined the efficacy of relaxation techniques in a sample of HIV patients without AIDS in the early stages after infection, by comparing the three groups: relaxation group (progressive muscle relaxation and modified autogenic training); ordinary supportive psychotherapy group, and finally no psychiatric treatment group. Scores for anxiety, fatigue, depression and confusion , as measured by the profile of mood states (POMS), were significantly lower after relaxation than before. There were no significant differences in the POMS scores (except for anger ) among the three groups. These two results suggest that a combination of progressive muscle relaxation and modified autogenic training is a useful method, which can be easily employed in HIV patients without AIDS.     

Comparison of two fetal growth curves in screening for high-risk neonates

The International Statistical Classification of Diseases and Related Health Problems (ICD-10) defines the 10th percentiles on the fetal growth curve as the cutoff point for light- and small-for-gestational-age infants, instead of the mean body weight ?1.5 standard deviation (SD) on the fetal growth curve, which has been used in Japan since 1983. Data on a 5260 sample of term neonates who were born during the 30-month period between January 1993 and June 1995 were obtained. The clinical usefulness of the 10th percentiles and mean bodyweight ?1.5 SD cutoff on the fetal growth curve as screening criteria for high-risk neonates of light- and small-for-gestational-age infants was evaluated. There was a statistically significant higher morbidity rate among the neonates whose birthweight was below mean bodyweight ?1.5 SD than for those whose birthweight was below the 10th percentile cut off. But there was no significant difference between the morbidity rate of neonates whose birthweight was between mean bodyweight ?1.5 SD and the 10th percentile cutoff and the morbidity rate of neonates whose birthweight was above the 10th percentile cutoff. Therefore, mean bodyweight ?1.5 SD on the fetal growth curve is a more effective means of screening for high-risk light- and small-for-gestational-age infants than the 10th percentile cutoff on the fetal growth curve.     

Correlation between daytime activities and night sleep of aged individuals estimated by wrist activity and sleep log

Abstract The daytime and night-time activities in 15 aged subjects was studied using a wrist-worn activity device. A significant negative correlation between the amount of daytime and night-time activities was found ( γ = 0.26, P < 0.01). There was a significant gender difference relating to the amount of daytime activity; women had significantly greater amount of daytime activity than did the men ( P < 0.001). These results suggest that aged people with higher daytime activity sleep better than those with lower daytime activity and that nocturnal sleep in women may be less disturbed.