Effects of Hypophysectomy on Patients With Advanced Breast Cancer in Relation to Pituitary Hormone Reserve Before and After the Operation

In four patients with advanced breast cancer, the TSH, prolactin,LH and FSH reserve was measured, before and after hypophysectomy,by stimulation with TRH and LH-RH. Two out of the four patientswere objectively improved following the operation. It was foundthat the clinical effects of hypophysectomy did not correlatewith changes in secretion of any of these pituitary hormones.In addition, the complete absence of pituitary hormones afteroperation did not necessarily mean that treatment had been effective. ^*This study was supported by Grants for Cancer Research andfor Specific Diseases from the Ministry of Health and Welfareand by a Grant-in-Aid for Cancer Research from the Ministryof Education, Science and Culture, Japan     

Investigation of melena and hematochezia as the chief complaint of gastrointestinal bleeding in pediatric surgical patients

The causes of melena or hematochezia in 48 pediatric patients were examined. Malrotation with volvulus was an important cause of hemorrhage during the newborn period, and intussusception was very typical in patients aged from 1 month to 1 year. Polyps of the rectum and colon were the most common causes of melena or hematochezia in patients older than 1 year. No cause of melena or hematochezia could be identified in 11 children. Ten patients have remained in good health with no further episodes of melena or hematochezia. Localized multiple polyps of the rectum with focal carcinoma were detected in only one patient. In general, although no further investigation is required after detection of the cause of bleeding and its successful treatment, it should be kept in mind that gastrointestinal malignancy can occur in children.     

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.     

Peptide Hormone Production in Small Cell Lung Carcinomas with Particular Reference to Gastrin-Releasing Peptide

Tissues of 50 small cell lung carcinomas were examined for productionof 17 peptide hormones. Only when the concentration of a peptidedetected in the tumor was 10 pmol or more per g wet weight,was the peptide considered to be produced by the tumor. Thefrequency of production of at least one of these peptide hormoneswas 84%, and that of two or more hormones was 50%. These resultsindicate that peptide hormone production is a very common phenomenonin small cell lung carcinoma. Of the peptide hormones examined,gastrin-re leasing peptide is produced with the highest frequency,suggesting that this pep- tide could play an important rolein small cell lung carcinoma.     

Activities in Detection of Ectopic ACTH Producing Tumors

A study group on ectopic hormone-producing tumor was organizedin Japan in 1967. During the first three years, this group conductedendocrine screening tests on 438 cases of malignant tumor consistingmainly of carcinoma of the lung, and detected ectopic ACTH-producingtumor in four cases of carcinoma of the lung and one case ofcarcinoma of the colon. It was noted that typical clinical signsof Cushing's syndrome were lacking in all five cases, suggestingthe importance of screening tests. In all these cases, urinaryexcretion of 17-OHCS and the level of plasma cortisol, whichdexamethasone failed to suppress, were high. Clinical picturerevealed edema, pigmentation and hypertension. Laboratory findingsincluded hypokalemia and a high degree of impairment of glucosetolerance. Concentration of ACTH in tumor tissue measured byradioimmunoassay was considerably higher than that measuredby bioassay.     

Occurrence of acute megakaryoblastic leukemia in a patient with idiopathic growth hormone deficiency

We describe a case of a 15 year old boy who developed acute megakaryoblastic leukemia (AMKL) while receiving treatment with human growth hormone (hGH) for idiopathic growth hormone deficiency (GHD). He was diagnosed as having idiopathic GHD and given hGH from December 1991. The examination of his peripheral blood showed mild pancytopenia 2 months before the start of the hGH therapy. Since January 1992, paleness of the skin, general fatigue and fervescence progressed gradually. In February 1992, because of the occurrence of acute leukemia, administration of hGH was discontinued. Judging from the results of surface marker analysis of the blast cells, the patient was diagnosed as having AMKL. He was treated with chemotherapy for acute non-lymphoblastic leukemia from March 1992. A complete remission was obtained after 4 weeks of treatment. The chemotherapy was completed in July 1993. He remains in complete remission 26 months after diagnosis. This case suggests the importance of hematological examination and, when there is any abnormality which is not caused by GHD, such as pancytopenia, more detailed medical examinations (for example bone marrow examination) are necessary.     

Stomach Compression Signs on Uppergastrointestinal X-Ray Examination as a Guide for Detecting Pancreatic Disease

Seven hundred and fifty-three patients with various abdominalcomplaints were examined by an upper gastrointestinal x-rayseries, and a few films were taken at the marked right anterioroblique or lateral position after the stomach was sufficientlydistended with air. One hundred and sixty-four patients whohad no palpable abdominal tumor were found to have compressionsigns on the upper part of the stomach. Seventy-nine of the164 patients proceeded to endoscopic retrograde cholangio-pancreatographyand other studies, which revealed six cases of pancreatic carcinomalocated at the body or tail, two cases of pancreatic cyst andone case of adrenocortical adenoma.