Development of hepatocellular carcinoma in a man with auto-immune chronic active hepatitis

A 57 year old man with auto-immune chronic active hepatitis, regularly treated with immunosuppressive therapy, had hepatocellular carcinoma (HCC) 10 years after diagnosis of the hepatitis. Assays of the hepatitis C virus antibodies against capsid and non-structural proteins revealed seronegativity in serial serum samples of this patient stored in the previous 10 years during follow up. The seronegative hepatitis C antibodies excluded hepatitis C virus as the cause of the HCC. The occurrence of HCC in this case suggests the necessity of surveillance for early detection of liver cancer in patients with auto-immune chronic active hepatitis undergoing long-term immunosuppressive therapy.     

Effect of atropine on responses of exocrine pancreas and plasma cholecystokinin to intraduodenal amino acids in dogs

The effect of atropine on responses of exocrine pancreas and plasma cholecystokinin (CCK) to intraduodenal mixed amino acids has been studied in conscious dogs with Thomas gastric and duodenal fistulae. Intraduodenal amino acids provoked significant increase of pancreatic protein output and of plasma CCK concentration. Atropine significantly reduced protein output only in the initial peak after amino acid administration. Atropine had no significant effect on plasma CCK. It is indicated that cholinergic nerves predominate in the early pancreatic protein response to intraduodenal amino acids and CCK prevails in the later phase, though these two factors do not seem to be the only factors responsible for the secretion.     

Evaluation of the therapy for streptococcal pharyngitis using Abbott Test Pack® Strep A

A total of 953 children (511 boys and 442 girls) with streptococcal pharyngitis diagnosed with Abbott Test Pack® Strep A (ATPSA) or throat cultures were analyzed. ATPSA specimens were repeatedly obtained until ATPSA turned negative during or after the treatment. The percentage of positive ATPSA specimens reached the lowest value (9.2%) on the fourth day of the course of the treatment, which indicates the acquisition from an infected individual is probably uncommon after the initial treatment. Bacteriological treatment failure (positive ATPSA after 14 days of treatment) occurred in 4.1% of the children. Out of 953 subjects studied, 216 (22.7%) had recurrent infections. More than 30% of the recurrent infections occurred within 2 months after initial infection. ATPSA is useful for establishing a rapid diagnosis and confirming the bacteriological success of the treatment.     

Accuracy of ultrasonography and magnetic resonance imaging in the diagnosis of non-palpable testis

BACKGROUND: Studies were needed to evaluate the accuracy of ultrasonography (US) and magnetic resonance imaging (MRI) for diagnosing non-palpable testis, and to study the clinical usefulness of US and MRI before surgical exploration. METHODS: Fifty-six patients with non-palpable testis aged 1--12 years were examined between 1993 and 2002. Forty-six patients (55 non-palpable testes) underwent US. Forty patients (47 non-palpable testes) were examined using MRI. Both US and MRI were used in 29 patients (34 non-palpable testes). We used Fisher's exact probability test to compare the results of these graphic examinations with the surgical or laparoscopic findings for the non-palpable testis. RESULTS: Ultrasonography had a sensitivity of 76%, a specificity of 100%, and an accuracy of 84% in the diagnosis of non-palpable testis, whereas MRI had a sensitivity of 86%, a specificity of 79%, and an accuracy of 85%. CONCLUSIONS: There were no statistically significant differences in the accuracy rates of US and MRI for diagnosing non-palpable testis. Laparoscopy or inguinal exploration should be performed even if these graphic examinations demonstrate the absence of a testis, because some patients with a non-palpable testis were found to be false negatives. We recommend US as the first step after clinical examination, and MRI could be performed when the US findings are negative preoperatively for a non-palpable testis.     

Congenital prepubic sinus: A variant of dorsal urethral duplication (Stephens type 3)

Abstract A 3-year-old boy was admitted for yellowish discharge from a tiny opening in the midline prepubic area on the dorsal base of the penis. No other symptom related to the genitourinary tract was noted. Sinuousgraphy showed a non-communicating sinus tract with the urinary tract. At surgical exploration, through a diamond-shaped incision, a 4.5 cm-long sinus was found that ended blindly as a fibrous cord at the anterior surface of the pubic symphisis. Histologically, it was lined by stratified squamous epithelium and surrounded by bundles of smooth muscle and collagen. According to Stephens' classification, the sinus appears to be a variant of dorsal urethral duplication of Stephens type 3.     

Angiogenesis in renal cell carcinoma: Evaluation of microvessel density, vascular endothelial growth factor and matrix metalloproteinases

BACKGROUND: Angiogenesis, the growth of new blood vessels, has a critical role in tumor growth and metastasis. The purpose of this study was to investigate the involvement of angiogenesis and angiogenic factors in the pathogenesis of renal cell carcinoma (RCC). METHODS: Formalin-fixed and paraffin-embedded tissue blocks from 70 patients with RCC were studied. The situations of tumor angiogenesis were evaluated by assessing microvessel density (MVD) through CD31 immunostaining. The expression of vascular endothelial growth factor (VEGF), matrix metalloproteinase-2 (MMP-2) and metalloproteinase-9 (MMP-9) was detected immunohistochemically. RESULTS: The value of MVD ranged from 12.0 to 93.0 with a median of 39.91 in RCC. Of the 70 RCCs, the expression of VEGF was detected in 52 (74.3%), MMP-2 in 29 (41.4%) and MMP-9 in 19 (27.1%) cases. Statistical analysis revealed significant associations of the tumor stage with MVD, and the expression of VEGF and MMP-2 in RCC. Additionally, MVD was closely related to the expression of VEGF but was not related to the expression of MMP-2 and MMP-9 in RCC. CONCLUSION: The degree of angiogenesis may be closely related to the tumor progression of RCC. The expression of VEGF may be responsible for angiogenesis in RCC, and both VEGF and MMP-2 expression may function as tumor associated angiogenic factors in RCC.     

Biocompatibility of Heparin-Coated Membrane Oxygenator During Cardiopulmonary Bypass

Abstract: The biocompatibility of the cardiopulmonary bypass (CPB) circuit, in which an oxygenator is solely heparinized, was assessed by systemic inflammatory reactions as an indicator during CPB. Fourteen patients, 11 males and 3 females, underwent coronary artery bypass surgery and were randomly divided into 2 groups of 7 patients each. For the heparin–coated oxygenator group (Group H), a heparin–coated membrane oxygenator was used in the CPB circuit, and in the control (Group C) an uncoated membrane oxygenator was employed. Systemic inflammatory reactions, such as platelet activation, prostaglandin production, complement activation, and activated granulocyte released substance, were measured prior to, during, and 6 h after CPB. The number of platelets decreased after protamine administration in both groups (14. 5 ±4. 7 times 10⁴/μl in Group H and 13. 8 ± 8. 7 times 10⁴/μd in Group C) and returned to baseline levels in Group H while it remained decreased in Group C at 6 h after CPB. The platelet factor 4 level was significantly lower in Group H (181 ± 40 ng/ml) than in Group C (297 ±131 ng/ml) after protamine administration. Thromboxane–B₂ (TXB₂) rose during CPB in both groups; however, there were significantly different levels of TXB₂ between the 2 groups at 60 min after CPB (293±258 pg/ml in Group H versus 408 ± 120 pg/ml in Group C) and after protamine administration (259 ± 122 pg/ml in Group H versus 709 ± 418 pg/ml in Group C). Plasma concentrations of granulocyte elastase were significantly lower in Group H at 30, 60 and 90 min, immediately after, and post–CPB than those of Group C. Although the oxygenator was solely heparinized in the CPB circuit, it was sufficiently effective to reduce inflammatory reactions during coronary artery bypass operation, and the heparin–coated surface seems to be more endothelium–like.