The effect of body respirator on the desaturation during the night in Duchenne muscular dystrophy

Recently body respirator (BR) has been used to control respiratory failure in patients with late stage Duchenne muscular dystrophy (DMD). We examined the effect of BR using a pulse oximeter. Arterial oxygen saturation (SaO2) for the night (21:00-7:00) was monitored in 15 DMD patients (5 cases without BR, 3 cases with BR partially for the night and 6 cases with BR all night long) and the desaturation (SaO2 less than 90%) time was followed three times (Jan. '87, Nov. '87, Apr. '88) in each patient. Desaturation time did not increase in 4 cases without BR. But in one case without BR it increased so much that we decided to put the patient on BR. In 3 cases with BR partially for the night, desaturation was well controlled when they used BR. No marked increase of desaturation was found in 4 cases with BR all night long. 2 of these cases were changed from cuirass type BR to jacket type BR and were getting on satisfactorily. Thoracic cage expansion of jacket type was larger than that of cuirass type, and it was found that jacket type was valuable. Also, we investigated the cause of desaturation by recording SaO2, nasal flow, thoracic cage motion and abdominal motion at the same time by making use of a polygraphy. The result showed that the main cause of desaturation was the resistance of thoracic cage motion against BR. And we think research and development is needed.     

Team approach of chemotherapy treatment for outpatients--a report from the chemotherapy treatment room at Kitasato University East Hospital

At Kitasato University East Hospital, the number of cancer patients who receive chemotherapy in the Chemotherapy Treatment Room for Outpatients (CTRO) is increasing (more than 200 a month). In order to enforce chemotherapy safely and efficiently, we are advancing a mutual collaboration between nurses and other occupations (doctors, pharmacists, etc.) in each ward and CTRO. First, we attained a unification of the system connecting each ward and developed the clinical path, progress nursing document (NCI-CTCAE ver. 3.0) and operating procedure. We keep the protocol for every patient in the file. Each occupation checks the protocol and patient's condition from each professional angle in order to prevent an accident. Moreover, the orientation for the patient by CTRO nurses is useful to create an image of their treatment process and makes the shift for patients from the ward to CTRO go smoothly. While the patients receive chemotherapy, the nurses grasp the patient's condition from various sides and support decision-making around the treatment. We collaborate with the committee and with study groups of nursing, which consist of a clinical nurse specialist and other occupations. We need to continue to improve the quality of medical treatment.     

Expression of vascular endothelial growth factor receptors is closely related to the histological grade of hepatocellular carcinoma

Angiogenesis is important for tumor growth, and is regulated by angiogenetic factors such as vascular endothelial growth factor (VEGF). In the present study, we investigated whether or not expression of VEGF receptors (VEGFRs) is related to the proliferation of tumor cells in hepatocellular carcinoma (HCC). We simultaneously stained proliferation marker Ki-67 antigen and either VEGFR1 (Flt-1) or VEGFR2 (Flk-1) on paraffin-embedded tissue sections from 50 cases of surgically resected human HCC. Based on the staining pattern of VEGFRs, we classified the cases into 4 categories; receptor double-negative, Flt-1 single-positive, Flk-1 single-positive, receptor double-positive. Interestingly, the Ki-67 index was significantly lower in receptor double-negative cases in comparison to that in either Flt-1 single-positive or Flk-1 single-positive cases (P = 0.0491, P = 0.0196, respectively). Moreover, the index was also significantly lower in receptor double-positive cases in comparison to either Flt-1 single-positive or Flk-1 single-positive cases (P = 0.0026, P < 0.0001, respectively). We further investigated 35 cases showing a Ki67 index > 10% to determine the expression of VEGFRs on Ki-67 antigen-positive proliferating cells. Surprisingly, the histological grade of HCC and the expression pattern of VEGFRs showed a characteristic relation; the well-differentiated HCC cases were all distributed in the Flk-1-positive group (7/7), moderately differentiated HCC cases were distributed in either the Flt-1 or Flk-1 single-positive group (20/21), and poorly differentiated HCC cases were predominantly distributed in either the receptor double-negative or double-positive group (6/7). These findings suggest that the expression pattern of VEGFRs influences the histological differentiation of HCC.     

Unusual extraperitoneal lesion of the pelvis: Cloacal cyst with transitional cell carcinoma

An unusual cystic tumor of retrovesical space was reported. After puzzling speculation on its histogenesis this extremely rate tumor was concluded to be a cloacal cyst with transitional cell carcinoma. Review of the literature revealed no similar case.     

Development of two cytogenetically abnormal clones from multipotential hematopoietic stem cells in a patient with juvenile myelomonocytic leukemia

We report a patient with juvenile myelomonocytic leukemia who had two cytogenetically independent clones at the time of diagnosis. Fluorescence in situ hybridization analyses showed that 42.5% of myeloperoxidase(+) cells and 27.3% of CD20(+) cells had three signals for chromosome 8, while 13.1% of myeloperoxidase(+) cells and 6.0% of CD20(+) cells had del (Y). However, a great majority of CD3(+) cells had no numerical aberration of the two chromosomes. The two karyotypically abnormal clones might have developed from multipotential hematopoietic stem cells with the potential to differentiate into myeloid and B-lymphoid lineages, but not T-lymphoid lineage.     

Podoplanin expression in odontomas: clinicopathological study and immunohistochemical analysis of 86 cases

Podoplanin, a sialomucin-like transmembrane glycoprotein, is currently used as a specific marker for lymphatic vessels. However, podoplanin expression has also been linked to tooth development. To investigate the expression of podoplanin in odontomas, 86 tissue samples were classified and then analyzed using immunohistochemical methods. Formalin-fixed, paraffin-embedded specimens were collected and classified, followed by immunohistochemical examination. The majority of the odontomas (66.3%) were the compound type, and the remainder (33.7%) were the complex type. The patients ranged in age from 2 to 89 years (mean, 23.9 years), and 45 (52.3%) of them were male and 41 (47.7%) were female. The most common location for complex odontomas was the molar region of the mandibular bone, and that for compound odontomas was the maxillary incisor region. Immunohistochemistry revealed that developing and mature odontoblasts, Tomes' fibers, and pulp cells near podoplanin-positive odontoblasts were positive for podoplanin. In addition, podoplanin positivity was evident in secretory ameloblasts, but not in mature ameloblasts. The pattern of podoplanin expression in odontomas corresponds to development of the tooth germ, and appears to be influenced by the stage of differentiation of the lesion, suggesting that the protein may participate in the process of differentiation.