Adenocarcinoma arising at the ileoileal anastomotic site of Scheele''s ring

Most tumors arising after augmentation ileocystoplasty have been reported to develop adjacent to the ileovesical anastomosis. Herein, we report a case of adenocarcinoma arising at the ileoileal anastomotic site 33 years after augmentation ileocystoplasty (Scheele's ring plasty) for tuberculous contracted bladder. The present case shows the possibility of late malignancy developing at the ileoileal junction after ileal neobladder.     

Immunopathogenesis of type C hepatitis: dendritic cell in HCV infection

Abstract   Dendritic cells (DCs) are professional antigen-presenting cells that enhance and regulate both innate and acquired immune reactions. It has been reported that several viruses actively down regulate DC function to escape from host immune system. To clarify the involvement of DC in anti-hepatitis C virus (HCV) immune reactions, we compared DC function between chronic hepatitis C patients and healthy donors. Monocyte-derived DCs generated from patients were relatively immature and were impaired in allostimulatory capacity and IL-12 p70 production when compared to that from donors. In addition, MDC and PDC in HCV-infected patients were reduced in number and impaired in their ability to promote Th1 polarization. These results demonstrate that DCs are numerically and functionally impaired in HCV-infected patients, which is critically involved in the pathogenesis and persistence of HCV infection.     

Survey of conformational role of ester bonds in a cyclic depsipeptide

The effect of ester bond on the conformation of peptide molecule was studied by designing and synthesizing a model tetradepsipeptide cyclo(-l -Ala-l -Hmb-)z and by analyzing the conformation both theoretically and experimentally. Theoretical analysis showed that both ester and peptide bonds in the calculated low-energy conformations within 3 kcal/mol of the global minimum take a trans but distorted configuration. The distortion is larger in ester bonds than in peptide bonds. Further, the four carbonyls project from one side of the plane of the cyclic backbone, whereas the side chains project from the other side. These results are consistent with the experimental results obtained by NMR measurement; first, the coupling constant deduced from ¹H-NMR species in DMSO-d₆ is consistent with the dihedral angles of the calculated low-energy conformations; second, results of NOE measurement can reproduce the calculated configuration of the carbonyls and side chains. From the consistency between theoretical and experimental results, it is concluded that this model tetradepsipeptide takes an all-trans backbone conformation in solution and this backbone conformation is stabilized by large distortion in the ester bond, which compensates the strain resulted from the 12-membered cyclic backbone structure consisting only of L-residues.     

Psychosocial and spiritual issues in terminal care

Abstract The author has been working as a psychiatrist over the past 30 years, engaging in clinical work and in research. During his career as a psychiatrist the author began to develop a special interest in terminal care. This led to additional study in a residency program in internal medicine and oncology, and culminated in the establishment of a hospice in 1984. Through this close association with hospice patients the author has experienced approximately 2000 deaths over the past 10 years. These experiences have reinforced in his mind the viewpoints that people die as a whole person.     

Early catheter removal 3 days after radical retropubic prostatectomy

AIM: We investigated the feasibility and safety of the early removal of urethral catheters 3 days after radical retropubic prostatectomy. METHODS: Seventy consecutive patients underwent radical retropubic prostatectomy with the intent of early catheter removal on postoperative day (POD) 3. Catheter removal was based on postoperative cystograms performed on POD 2. Patients were analyzed using a validated prostate cancer specific questionnaire (University of California, Los Angeles Prostate Cancer Symptom Index) to determine quality of life outcomes. Multiple logistic regression analysis was also used to evaluate if any of the preoperative or intraoperative parameters were able to predict the success of early catheter removal after radical retropubic prostatectomy. RESULTS: The catheter was removed on POD 3 in 67 of 70 patients (97%) excluding three patients with moderate or severe extravasation on postoperative cystograms. Of the 67 patients, 53 (76%) were successful in early catheter removal, but the remaining 14 (24%) patients experienced urinary retention within 48 h and were treated with simple catheter replacement for 1 or 2 days. Two patients developed anastomotic strictures 3 and 4 months postoperatively, which were managed by dilation alone. Multiple logistic regression analysis showed that no leak during an intraoperative leak test was the only independent predictor of success for early catheter removal (P = 0.0069; odds ratio, 6.667; 95% confidence interval, 1.682-26.428). CONCLUSION: The present study revealed that early catheter removal 3 days after radical retropubic prostatectomy is feasible in patients who show a negative intraoperative leak test. Postoperative monitoring of more patients is needed to determine if the early catheter removal is widely applicable.     

Intracavitary administration of OK-432 with subcutaneous priming for malignant ascites in a case of advanced renal cell carcinoma

The intracavitary injection of OK-432 (a streptococcal preparation) with subcutaneous priming has been shown to be an effective immunotherapy for patients with malignant effusion. We applied this treatment in a case of advanced renal cell carcinoma with massive ascites. The patient received 0.2 Klinishe Einheit (KE) OK-432 in the subcutaneous injection twice (day 1 and day 7) followed by 10KE OK-432 intra-abdominal administration (day 9). The treatment was performed safely without major side-effects except for transient pyrexia. A significant reduction of ascites was noted 1 month after the treatment without subsequent re-accumulation. Intracavitary injection of OK-432 with subcutaneous priming seems to be a simple, safe and effective treatment for ascites in advanced renal cell carcinoma.     

High rate of mixed genotypes of hepatitis C virus in patients of an epidemic area in Japan

The subjects of this study were 151 patients (69 males and 82 females) who underwent examination and liver biopsy owing to liver dysfunction in an epidemic area with hepatitis C. Second generation hepatitis C virus antibody (HCV Ab) was positive in 116 (76.8%) of 151 cases. HCV-RNA was detected in 120 (79.5%) by polymerase chain reaction (PCR). In 7 (4.6%) cases, HCV Ab could not be found, but HCV-RNA was detected. Three (2.0%) cases were positive for HCV Ab but negative for HCV-RNA. On the basis of variation in nucleotide sequence within a restricted region in the putative core gene of HCV, HCV genotypes were classed into four types of I, II, III and IV by PCR. The genotypes were identified in 120 cases. Ninety-eight (81.7%) cases carried one of the four types. Type II was found in 76 (63.3%) cases and type III in 22 (18.3%). The other 22 (18.3%) carried simultaneously two different genotypes (mixed type): 21 (17.5%) cases with type II + III and one (0.8%) case with type II + IV. In comparison with the incidence of HCV mixed types in cases with hepatitits C in a non-epidemic area, carriers of mixed types were found at a significantly higher rate in the epidemic area. Liver biopsy of 120 cases with identified HCV genotypes in the epidemic area showed 93 cases of chronic active hepatitis, nine of chronic lobular hepatitis, 10 of chronic persistent hepatitis and eight of liver cirrhosis. No significant correlation could be detected between liver histology and HCV genotypes. Of the 120 cases, 63 (52.5%), 54 (45.0%) and 12 (10.0%) cases had past histories of folk remedies accompanying bleeding, operation and transfusion, respectively. The repetition of these medications may have caused a high ratio of carriers of the mixed genotypes of HCV.     

Differences in symptom structure between panic attack and limited symptom panic attack: A study using cluster analysis

Abstract We had investigated the clinical characteristics of panic disorder (PD) in a Japanese outpatient population comprised of more than 250 patients diagnosed as having PD during a 13-year study period and observed that some PD patients had both panic attacks (PA) and limited symptom panic attacks (LPA). In the criteria for PD based on the Diagnostic and Statistics Manual of Mental Disorders , third edition-revised ( DSM-III-R ), episodes involving four or more symptoms are classified as PA, while those involving fewer than four symptoms are described as LPA. Therefore, LPA is identified as part of an episode of PA, since the difference between the two episodes is only in the number of symptoms. However, some recent research suggests that there is a distinct subgroup of individuals who suffer LPA. Using cluster analysis, we investigated the differences between PA and LPA groups in terms of the structures of several panic symptoms, which included anticipatory anxiety, agoraphobia and 13 clinical symptoms based on the DSM-III-R at the time of panic attacks, in 247 patients with PD. Cluster analysis revealed clusters of three and four panic symptoms in the PA group and LPA group, respectively, and there were also differences in symptom structure between the two groups. These results suggest that there may be a subgroup of individuals who show LPA among PD patients.