AN AUTOPSY CASE OF DIPROSOPUS

A case of diprosopus, a very rare malformation belonging to dupli-citas, of a female newborn is reported. This diprosopus monauchenos tetrophthalmus triotus dioris was delivered from a 33 years old multipara. Autopsy revealed duplication of cerebral hemispheres, 1st, 2nd and 3rd cranial nerves, hypophysis, intracranial internal carotid arteries, basilar artery and tip of tongue. This diprosopus had also congenital cardiac and great vessel anomalies consisting of double outlet right ventricle without pulmonary stenosis, coarctation of aorta (infantile type), ventricular septal defect, patent ductus arteriosus, patent foramen ovale and thick right ventricular wall. Except for mesenterium commune, the organs in the chest and abdomen, and the extremities were normal in position, shape and number. ACTA PATH. JAP. 20: 239–249, 1970.     

Serum Levels of Phenytoin and Phenobarbital in Epileptic Patients treated with Mixture Antiepileptic Tablets, Comital-L or Hydantol-F

Serum levels of both phenytoin and phenobarbital were determined by homogenous enzyme immunoassay in 59 epileptic patients treated chronically with either Comital-L or Hydantol-F tablets. The majority of the patients receiving Comital-L tablets showed low serum levels of phenytoin and high serum levels of phenobarbital, while patients treated with the usual daily dosage of Hydantol-F tablets showed adequate therapeutic serum levels of both phenytoin and phenobarbital. From the results obtained, the dose ratio of phenobarbital to phenytoin in Comital-L tablet seemed inappropriate to obtain adequate therapeutic serum levels of both drugs simultaneously. Since the dosage of each anticonvulsant drug used concurrently should be established individually, the use of such fixed-dosage mixture tablets of antiepileptic drugs as Comital-L or Hydantol-F in daily clinical practice should be reconsidered from the viewpoint of serum level monitoring of antiepileptic drugs.     

Negative association between serum dioxin level and oxidative DNA damage markers in municipal waste incinerator workers

Objectives: To investigate the effect of dioxin on the formation of oxidative DNA damage and urinary mutagenicity, we measured the concentrations of serum dioxins and lymphocytic 8-hydroxydeoxyguanosine (8-OH-dG) in 57 male waste incinerator workers, urinary 8-OH-dG and urinary mutagenicity in 29 male waste incinerator workers. Methods: Information about the subjects was obtained from a questionnaire. Concentrations of polychlorinated dibenzo-p-dioxin (PCDD), polychlorinated dibenzofuran (PCDF), and coplanar-polychlorinated-biphenyl (Co-PCB) in serum samples from the workers were measured with a high-resolution gas chromatograph /high-resolution mass spectrometer. Lymphocytic and urinary 8-OH-dG levels were measured with a high-performance liquid chromatography-electrochemical detector system. The urinary mutagenicity was measured with umu assay. Results: The lymphocytic 8-OH-dG level showed a negative association with the serum dioxin level (total value of TEQ-PCDD, PCDF, and Co-PCB). Urinary 8-OH-dG did not show correlation with serum dioxin level, but showed positive correlation with the smoking index. Conclusions: With respect to the subjects‘ serum dioxin level, dioxin did not increase the urinary 8-OH-dG level by oxidative DNA damage, but upregulation of the primary defenses with oxidative damage and/or DNA repair system activity might have occurred.     

Therapeutic potential of endothelial progenitor cells for cardiovascular diseases

In the past decade, researchers have defined committed stem or progenitor cells from various tissues, including bone marrow, peripheral blood, brain, liver and reproductive organs, in both adult animals and humans. Recently, endothelial progenitor cells (EPCs) were isolated from peripheral blood mononuclear cells and were shown to be incorporated into foci of neovascularization. This finding that circulating EPCs may home into sites of neovascularization and differentiate into mature endothelial cells in situ is consistent with the concept of 'vasculogenesis' and suggests that vasculogenesis and angiogenesis might constitute complementary mechanisms for postnatal neovascularization. Furthermore, experimental and clinical studies on ischemic cardiovascular diseases suggest a therapeutic potential for EPC transplantation. In this review, we summarize the biological features of EPCs and discuss their therapeutic potential for the treatment of cardiovascular diseases.     

Prognostic impact of orotate phosphoribosyl transferase activity in resectable colorectal cancers treated by 5-fluorouracil-based adjuvant chemotherapy

BACKGROUND AND OBJECTIVES: Phosphoribosylation of 5-fluorouracil (5-FU) is an essential step which leads to tumor growth inhibition and orotate phosphoribosyl transferase (OPRT) is the main enzyme that involves in this conversion of 5-FU to 5-fluorouridine monophosphate. This retrospective study was aimed to evaluate the correlation between tumor OPRT activity and the clinical outcome in colorectal cancer (CRC) patients treated by oral 5-FU-based adjuvant chemotherapy. METHODS: Surgical specimen was obtained from resectable 124 CRC patients who were subsequently treated by oral 5-FU-based adjuvant chemotherapy. OPRT activity in the extract of tumor tissue was enzymatically determined. The cut-off value of intratumor OPRT activity against disease free survival was determined by maximal chi2 method. The disease free survival and overall survival in each group were calculated using the Kaplan-Meier method. RESULTS: Patients were divided into two groups by determined cut-off value of intratumor OPRT (0.147 nmol/min/mg protein) (high group: n = 102, low group: n = 22). Five-year DFS (P = 0.035) and OS (P = 0.020) were significantly better for high OPRT group. CONCLUSIONS: This study demonstrated that an assay of tumor OPRT contributes to the determination of 5-FU-based adjuvant chemotherapy outcome and application in clinical practice should be included in tumor analysis prior to 5-FU-based adjuvant chemotherapy.     

Potential role of chemo-radiation with oral capecitabine in a breast cancer patient with central nervous system relapse

A 54-year-old woman underwent mastectomy and axillary lymph node dissection for infiltrating ductal carcinoma with multiple lymph node involvement. The patient received adriamycin 60 mg/m(2) and cyclophosphamide 600 mg/m(2) (AC) followed by weekly paclitaxel 80 mg/m(2) and external irradiation to the local lymph node regions as adjuvant treatment. After 1 year and 5 months, the patient suffered her first recurrence, developing multiple brain and meningeal metastases. CNS involvement was well controlled by oral capecitabine (2400 mg twice daily, on days 1-21 of a 28-day cycle) and external whole brain irradiation of 50 Gy with minimal toxicity. We suggest that capecitabine contributed to the favorable clinical course in this patient and believe that, as an oral agent, this drug may benefit patients with CNS metastases of breast cancer by allowing home-based therapy.     

Simple and easy method for chordal reconstruction during mitral valve repair

We describe a simple reproducible method for chordal replacement using expanded polytetrafluoroethylene sutures during a mitral valve repair. With this technique, fine length adjustments of the new chordae are easy to make and it is possible to tie the two ends of the suture securely without slippage.     

Mask anesthesia for cerebral angiography in childhood moyamoya disease

Cerebral angiography is performed for diagnosis and management of moyamoya disease and in childhood moyamoya disease is usually carried out under general anesthesia after tracheal intubation. Mechanical irritation to trachea resulting in pain,cough,and increase in secretion after termination of the general anesthesia sometimes occurs and it sometimes causes hyperventilation resulting in hypocapnea. Continuous hypocapnea sometimes causes appearance of ischemic attacks in moyamoya disease. In the present study, we examine cerebral angiography conducted under general anesthesia using face mask ventilation in fourteen children with moyamoya disease. Sevoflurane was used as inhalation anesthetics. Face mask anesthesia was sixteen times in total in the 14 patients. Cerebral angiography terminated uneventfully in these patients except one patient who showed bronchospasm after induction of anesthesia and required tracheal intubation. However, the patient showed uneventful course after termination of the angiography. Tracheal irritation did not appear and all the patients were asleep just after termination of face mask anesthesia except for the patient who required tracheal intubation. In the latter case, the patient frequently coughed out phlegm after general anesthesia with tracheal intubation. In conclusion, general anesthesia with face mask ventilation was thought to be one of the suitable anesthetic methods introduced for cerebral angiography in childhood moyamoya disease.     

Complications and long-term follow-up results in titanium mesh cage reconstruction after cervical corpectomy

OBJECTIVE: The incidence of the complications and long-term outcome with a minimum 2-year follow-up of anterior cervical reconstruction using titanium mesh cage is evaluated. Relevant literature was also reviewed to discuss the potential risk factors of the complications of this procedure. METHODS: From 1999 to 2003, 26 patients with cervical spine disorders, (12 patients with OPLL, 7 with cervical spondylosis, 3 with vertebral tumors, 2 with osteomyelitis, and 2 with traumatic lesions) were operated on by this procedure. The series included 14 males and 12 females with a mean age of 60.9 years. Corpectomy was performed on 1 (14 cases), 2 (12 cases). Autologous bone fragments were taken from the excised vertebra. RESULTS: The average improvement rate as scored on the neurosurgical cervical spine scale was 67.4%. The average follow-up period was 54.3 months (range, 24 to 72 months) in 21 who were followed up, and bone union was observed in all cases (22/22 cases) that could be followed up for more than 6 months postoperatively. The average time required for fusion was 6.7 months. Postoperative complications included dyspnea (1 case) and cerebrospinal fluid leakage (2 cases), which was treated by lumbar drainage, without any additional repair operation. No hardware-related complications or adjacent segment degenerative changes were encountered during the follow-up periods. CONCLUSIONS: This reconstruction technique yielded good clinical results and helped to avoid complications associated with harvesting bone from the iliac crest donor site. However, risk factors related to the method should be carefully considered.