Primary cardiac malignant lymphoma diagnosed intraoperatively during aortic valve repair; report of a case

A 58-year-old male who complained of chest oppression on effort was diagnosed as aortic regurgitation by echocardiography. The cardiac catheterization was showed moderate aortic regurgitation. He was referred to our hospital for aortic valve replacement. We considered preoperatively that the aortic regurgitation is due to infective endocarditis or aortitis syndrome. We have not noticed cardiac tumor at all until aortic valve replacement. Postoperative pathological diagnosis of the tumor was malignant lymphoma. The tumor had a characteristic architecture of a cardiac MICE (mesothelial/monocytic incidental cardiac excrescence). After the operation, additional chemotherapy using doxorubicin and cysplatin was performed. The patient has been doing well for 5 years after operation.     

Predominant location of pulmonary parenchymal lesions of tuberculosis primary complex in infants aged less than one year

It is useful to know the distribution of pulmonary lesions in the diagnosis of tuberculosis on radiological examination. The aim of this study was to investigate if there is predominant lung segment or lobe for tuberculous lesions in infants aged less than one year using contrast enhanced CT. We studied 57 infants (40 boys, 17 girls) who were diagnosed as tuberculosis by isolation of Mycobacterium tuberculosis or combination of family contact, radiographic findings suggesting tuberculosis, and positive reaction of 5 mm or more induration to PPD tuberculin. All the infants had lesions in mediastinal and/or hilar lymphonodes, and 54 out of 57 infants had parenchymal lesions as well. In the study of the segmental predominance of tuberculous lesions, each infant had a share of 100 points. If an infant had a single focus, all the points were distributed to the corresponding segment. If he or she had multiple foci, the 100 points were equally divided into affected lung segments. There was no significant difference between right (3385 points/10 segments) and left (2005 points/8 segments) lungs. The points in upper lobes (2224 points/5 segments) were significantly higher than the combined points of middle and lingual (896 points/4 segments) and lower (2270 points/9 segments) lobes (p < 0.05). The points in posterior lung segments (2839 points/7 segments) were significantly higher than the combined points of middle (436 points/3 segments) and anterior (2115 points/8 segments) lung segments (p < 0.05). These results suggest that upper lobes and posterior segments are predominant parenchymal regions of tuberculosis among infants less than one year, although tuberculous lesions may locate in any lung segment.     

Case mix based payment and DPC from an international perspective

The basic principle of Diagnosis Related Groups (DRG) is to classify patients according to the combination of diagnosis and procedures. The first DRG developed by research at Yale University was adopted for the per-case-payment American Medicare scheme for hospital fees under a DRG/PPS (prospective payment system). This scheme has been refined continuously and adopted as payment systems in other countries. The DPC-based reimbursement scheme in Japan consists of two components; a DPC component and a Fee-For-Service (FFS) component. The DPC component corresponds to the "so-called" hospital fee, includes the hospital basic charge, the pharmaceuticals and supplies used in wards, lab-test, radiological examination, and any procedures costing less than 10,000 yen. The FFS component corresponds to the charges for surgical procedures, pharmaceuticals and supplies used in operation rooms, and procedures costing more than 10,000 yen. For the DPC component, a per diem payment schedule is set for each DPC group. One of the most important objectives in introducing the DPC scheme is to ameliorate the transparency of hospital activities in Japan. The DPC system is expected to make hospital services measurable, and then to provide a common ground for discussion among interest groups over the optimal policy to maintain a sustainable Japanese medical care system. However, in order to keep DPC more reliable, much must be done to refine the DPC version 3. For example, development of CCP (Co-morbidity-Complication-Procedure) matrix is now ongoing to more properly describe the resource consumption of each DPC group. It is also important how to evaluate nursing services, ICU services and expensive drugs and materials within the DPC sheme.     

Role of phenobarbital-inducible cytochrome P450s as a source of active oxygen species in DNA-oxidation

We investigated the biological effects of the active oxygen produced by P450s. First, we identified which isoforms of P450 efficiently produced active oxygen using electron spin resonance. Eight forms of P450 purified from rat liver were used. Of these, CYP1A2, 2B1, 2C11 and 3A2 produced hydroxyl radicals efficiently. Phenobarbital (PB) which is a typical inducer of CYP2B1 and 3A2 induced production of hydroxyl radicals by rat liver and ketoconazole, an inhibitor of P450, inhibited production of hydroxyl radicals in vitro. PB is a tumor promoter as well as the P450-inducer. We investigated oxidation of the genomic DNA by the hydroxyl radicals produced by PB-inducible P450 in vitro and in vivo. 8-hydroxy-2'-deoxyguanosine (8-OHdG), a biomarker of DNA oxidation in vivo was assayed by HPLC. PB strongly induced the production of 8-OHdG in the rat liver. While ketoconazole inhibited the production of 8-OHdG in vivo. These results suggest that active oxygen produced by P450 oxidized genomic DNA and induction of P450 increased oxidative stress that may contribute to tumor initiation and promotion.     

Lindera strychnifolia is protective against post-ischemic myocardial dysfunction through scavenging hydroxyl radicals and opening the mitochondrial KATP channels in isolated rat hearts

Lindera strychnifolia (tendai-uyaku), a medicinal plant, has long been used for the treatment of cardiac, renal and rheumatic diseases in Japan. We aim to clarify (1) whether L. strychnifolia is protective against post-ischemic myocardial dysfunction, and (2) whether its effect is related to scavenging hydroxyl radicals and opening the mitochondrial KATP channels in isolated rat hearts. Male Sprague-Dawley rats were orally given 1 ml/day of L. strychnifolia, which was extracted from 0.75 and 1.5 g/kg of roots of L. strychnifolia for 4 days. The rat hearts were excised and perfused on a Langendorff apparatus with Krebs-Henseleit solution with a gas mixture of 95% O2 and 5% CO2. The hearts were paced at 320 beats/min except during ischemia. Left ventricular developed pressure (LVDP, mmHg), +/- dP/dt (mmHg/sec) and coronary flow (ml/min) were continuously monitored. All hearts were perfused for a total of 120 minutes consisting of a 30-minute pre-ischemic period followed by 30 minutes of global ischemia and 60 minutes of reperfusion with or without 5-HD, a mitochondrial KATP channel blocker. The levels of lactate, LDH and 2,5-DHBA, an indicator of hydroxyl radicals, in the perfusate during reperfusion period were also measured. Treatment with L. strychnifolia significantly improved LVDP and +/- dP/dt without altering coronary flow during reperfusion. The 100 microM of 5-HD in Krebs-Henseleit solution was perfused during the 10 minutes of pre-ischemic periods. Pretreatment with 5-HD abolished the improvement of LVDP and +/- dP/dt by L. strychnifolia. L. strychnifolia significantly attenuated the levels of lactate, LDH and 2,5-DHBA during reperfusion, and which were restored by pretreatment with 5-HD. In conclusion, L. strychnifolia is protective against post-ischemic left ventricular dysfunction through scavenging hydroxyl radicals and opening the KATP channels in the isolated rat heart.     

Influence of renal function on clinico-pathological features of primary hyperparathyroidism

OBJECTIVE: Disturbed renal function may play an important role in the clinico-pathological presentation of primary hyperparathyroidism (pHPT). We studied the influence of renal function on the clinico-pathological characteristics of 141 patients (123 women and 18 men) with surgically proven pHPT. METHODS: The 141 patients were assigned to one of two groups based on creatinine clearance (C(cr)) level: a renal insufficiency group (n=37) in which C(cr) of patients was <70 ml/min and a normal renal function group (n=104) in which C(cr) was > or =70 ml/min. Clinical presentation and biochemical indices were evaluated and compared between the two groups. RESULTS: Age, and frequency of hypertension and of diabetes mellitus were significantly (P<0.001, P<0.05 and P<0.05 respectively) higher in the renal insufficiency group than in the normal renal function group. Serum levels of calcium, intact parathyroid hormone and bone Gla protein were significantly (P<0.05) higher and the excised parathyroid weighed significantly more (P<0.05) in the renal insufficiency group than in the normal renal function group; however, serum 1,25-dihydroxyvitamin D (1,25(OH)(2)D) and 24 h urinary calcium excretion were significantly (P<0.001 and P<0.05 respectively) lower in the former than in the latter group. There was a significant inverse correlation between C(cr) level and serum calcium (r=0.315, P<0.001) and a significant positive correlation between C(cr) level, 1,25(OH)(2)D (r=0.315, P<0.001), and 24 h calcium excretion (r=0.458, P<0.0001). CONCLUSIONS: Clinico-pathological features of pHPT were notably influenced by even moderate renal insufficiency. Urinary calcium excretion decreased according to the decrease in glomerular filtration rate. Therefore, endocrinologists need to appraise urinary calcium excretion and renal function of pHPT patients when considering surgery or in discriminating familial hypocalciuric hypercalcemia.