Present Situation of Eus‐Fnab in our Institute and Future Appropriate Direction of This Procedure in Japan

We describe the present view of performing diagnostic endoscopic ultrasonography guided fine needle aspiration biopsy (EUS‐FNAB). In the pancreatic diseases, our application of EUS‐FNAB for pancreatic disease has been as follows: as to the operable cases, EUS‐FNAB should not be performed through any pathway penetrating the duodenum and the stomach. EUS‐FNAB is contraindicated in cystic diseases. As to the cases diagnosed as inoperable with various imaging modalities, EUS‐FNAB should be performed to obtain the pathological evidence. In gastrointestinal disorders, all intramural diseases are appropriate indications for this procedure. Even if the target lesion is in the far oral part of the large intestine, we perform EUS‐FNAB by the special method described in this paper. Lymphadenopathy for appropriate cases is one of the best cases in which to perform EUS‐FNAB. Mediastinal lymph node metastasis influences the treatment plan of lung cancer; the application of this treatment is increasing in our institute.     

Hepatic Proteins in Regenerating Liver

Abstract  Albumin immunoreactivity in the liver was examined on days 2, 5 and 10 after two-thirds partial hepatectomy by light and ultrastructural immunoperoxidase methods and the ultrastructural area of the rough endoplasmic reticulum (ER) in hepatocytes was measured. Albumin immunoreactivity was seen in the rough ER and Golgi apparatus of all hepatocytes in the hepatectomized liver and ultrastructural analysis showed a significantly greater area of rough ER on day 5 than on days 2 or 10. Albumin mRNA was studied by the in situ hybridization technique using radioisotopes and their numbers were determined visually. Albumin mRNA was present as grains in all hepatocytes and the grains varied in number during regeneration of the liver, being more abundant on day 5 than on days 2 or 10. The activity of [³H]-leucine incorporated into albumin synthesis, an indicator of translational activity, was higher on days 5 and 10 than on day 2 and was highest on day 5. In conclusion, albumin synthesis varied during liver regeneration after partial hepatectomy, being reduced at the peak of cell proliferation on day 2 and being most active on day 5.     

Plasma thrombopoietin level and platelet indices in hemodialysis patients receiving recombinant human erythropoietin

We focused on thrombocytopenia in hemodialysis patients (HD) receiving recombinant human erythropoietin (rHuEPO) and investigated thrombopoietin (TPO) level and platelet indices. We analyzed platelet parameters including mean platelet volume (MPV), platelet-crit (PCT), mean platelet component (MPC) concentration and platelet count (PLT) using ADVIA 2120 in 375 HD patients. This study included 25 HD patients undergoing treatment with rHuEPO at 9000 IU/week. These patients were divided into two groups by reference PLT of 130 × 10⁹/l [eight patients with low PLT (L-PLT group) and 17 patients with normal PLT (N-PLT group)], and TPO level and platelet indices in each group were compared with those in nine HD patients not receiving rHuEPO. In HD patients, the mean value of MPV was slightly higher and the mean values of PLT, PCT, and MPC were significantly lower than those in healthy controls. TPO levels were significantly higher in patients receiving rHuEPO than in patients not receiving rHuEPO. However, no significant difference was found between TPO levels in patients in the L-PLT group and patients in the N-PLT group. TPO levels were not correlated with PLT in these patients and that MPC levels decreased remarkably regardless of PLT.     

LEVELS OF VITAMIN D-METABOLITES IN A CASE OF ACRO-OSTEOLYSIS SYNDROME

ABSTRACT. On the initial examinations of a 17-year-old boy with acro-osteolysis syndrome, the levels of serum 25-hydroxycholecalciferol (25OHD) were low, whereas serum levels of 1,25-dihydroxycholecalciferol (1,25(OH)₂D) were normal. Administration of 1α-hydroxycholecalciferol (1OHD) failed to improve the osteoporosis, although the serum 25OHD level rose to normal. It is unlikely that impaired bone remodeling due to abnormal vitamin D-metabolism was a primary defect in our patient.     

Carpal bone movements in gripping action of the giant panda (Ailuropoda melanoleuca)

The movement of the carpal bones in gripping was clarified in the giant panda ( Ailuropoda melanoleuca ) by means of macroscopic anatomy, computed tomography (CT) and related 3-dimensional (3-D) volume rendering techniques. In the gripping action, 3-D CT images demonstrated that the radial and 4th carpal bones largely rotate or flex to the radial and ulnar sides respectively. This indicates that these carpal bones on both sides enable the panda to flex the palm from the forearm and to grasp objects by the manipulation mechanism that includes the radial sesamoid. In the macroscopic observations, we found that the smooth articulation surfaces are enlarged between the radial carpal and the radius on the radial side, and between the 4th and ulnar carpals on the ulnar side. The panda skilfully grasps using a double pincer-like apparatus with the huge radial sesamoid and accessory carpal.     

Gastrointestinal hepatoid adenocarcinoma: venous permeation and mimicry of hepatocellular carcinoma, a report of four cases

Aims : Four cases of hepatoid adenocarcinoma, three in the stomach, and one in the sigmoid colon, are presented to emphasize venous permeation and mimicry of hepatocellular carcinoma by metastatic liver nodules. Methods and results : Tumour cells in all cases extensively invaded veins, and intravenous tumour thrombi in two cases were grossly observed as anastomosing, worm-like cords up to 10 mm in diameter in the lesser omentum and mesentery in continuity with the primary mucosal lesions. The cytological features and trabecular architecture of the metastatic liver nodules in these subjects mimicked primary hepatocellular carcinoma. In a third case the tumour contained grossly visible bile in a metastatic lung nodule, but there was no evidence of bile production in the primary gastric or metastatic liver lesions. In the fourth case, detailed histopathological study revealed a gastric origin of the hepatoid adenocarcinoma, rather than primary hepatocellular carcinoma metastatic to the stomach, the initial diagnosis. Conclusions : These cases are reported here to draw attention to this rare variant of gastrointestinal adenocarcinoma, its mimicry of hepatocellular carcinoma when metastatic to the liver and other sites, and its propensity for venous permeation.     

Medical management and complications of X-linked hypophosphatemic vitamin D resistant rickets

To improve the growth failure, bowed legs, and biochemical and radiological abnormalities in patients with X-linked hypophosphatemic vitamin D resistant rickets (XLH), combined therapy of phosphate and calcitriol is the best therapeutic approach at present. However, the complications involving combined therapy, such as hypercalcemia, nephrocalcinosis and hyperparathyroidism, are not fully solved. To achieve better control, new therapeutic approaches have been reported recently, for example, growth hormone (GH) or new vitamin D analogs. GH improved linear growth, decreased phosphate reabsorption and increased 1-α-hydroxylase activity. Furthermore, 24R, 25-dihydroxyvitamin D₃ (24,25) improved the bone lesions in hypophosphatemic (Hyp) mice, and also in XLH, without the adverse effects such as hypercalcemia or hypercalciuria compared with 1,25-dihydroxyvitamin D₃. These new approaches should be considered for the treatment of patients with XLH.     

Preoperative predictors of cancerous involvement of the neurovascular bundles in patients with localized prostate cancer

BACKGROUND: The purpose of this study was to identify preoperative variables that would be useful in objectively selecting prostate cancer patients for nerve-sparing prostatectomy. METHODS: Twenty-six patients with clinical T1c-T2c cancers were evaluated for cancerous involvement in the region of the neurovascular bundles (NVB) from prostatectomy specimens. Preoperative prostate-specific antigen (PSA) and pathologic features in systematic biopsy specimens also were reviewed. RESULTS: A total of eight (31%) patients had cancerous involvement in the region of the NVB, including four on the right side, three on the left side and one on both sides. The percentage of each biopsy specimen occupied by the cancer was scored from zero to four and defined as the positive biopsy score. Preoperative PSA (P = 0.046), mean positive biopsy score (total sum of positive biopsy score divided by number of biopsy specimens; P = 0.001), number of cores containing cancer (P = 0.011), percentage of cores involved (P = 0.036) and maximum positive biopsy score (P < 0.001) were significant for predicting cancerous involvement in the NVB region using univariate analysis. However, only the mean positive biopsy score was independently significant according to multivariate analysis. To predict cancerous involvement in the region of each NVB, we found that ipsilateral mean positive biopsy score (total sum of corresponding positive biopsy score divided by number of ipsilateral biopsy specimens), number of cores involved on the ipsilateral side, percentage of cores involved on the ipsilateral side and maximum positive biopsy score on the ipsilateral side were significant predictive variables: the ipsilateral mean positive biopsy score being most appropriate for clinical practice. CONCLUSION: Ipsilateral mean positive biopsy score in systematic biopsy specimens can be an appropriate variable for selecting patients with localized prostate cancer for nerve-sparing prostatectomy.