Predictors of good prognosis in total anterior circulation infarction]

We analysed the predictive factors for relatively good prognosis in the patients with total anterior circulation infarction (TACI) defined by the Oxfordshire Community Stroke Project. One hundred patients with first-ever ischemic stroke within 6 hours of onset were enrolled. Outcomes were assessed at 3 months using the modified Rankin Scale (mRS), and rated as good if the mRS was 0 to 3, and as bad if the mRS was 4 or 5, or the patient was dead. These two groups were compared in terms of their clinical background, risk factors, vital signs, laboratory data, and cranial CT at the time of hospitalization and repeated CT at 24 to 48 hours after onset. There were 36 patients with good prognosis and 64 patients with bad prognosis. In univariate analysis, the patients with good prognosis were younger, had lower scores in the National Institutes of Health Stroke Scale (NIHSS, both total score and the score of consciousness sub-item), had fewer rates of deterioration within 7 days than the patients with bad prognosis. In the first cranial CT within 6 hours, the patients with good prognosis had fewer early CT signs including hyperdense middle cerebral artery sign, and brain swelling, as well as infrequent hypodensity more than 33% of total MCA territory, than the patients with bad prognosis. In the second CT during 24 to 48 hours, the patients with good prognosis had smaller lesions than the patients with bad prognosis. In multivariate analysis with logistic regression revealed that age < 70 years, low NIHSS score < or = 15, no deterioration in the acute phase, and small lesion on the second CT were independent predictors of good prognosis.     

Detection of polyamines by an enzymatic assay. (6). Fundamental and clinical studies of a simple enzymatic method for determining total polyamines in blood

A simple enzymatic method for determining total polyamines in human blood was established. Polyamines in trichloroacetic acid extract from 1 ml of blood were isolated on an anion-exchange column and measured spectrophotometrically by the end point assay using polyamine oxidase and putrescine oxidase. The recovery was as high as 98.4% and within-run precision (coefficient of variance: 1.82%), and the values obtained by this method were in fair agreement with those obtained by high performance liquid chromatography and the enzymatic differential assay methods previously reported. The polyamine levels were not changed when the blood was stored at -20 degrees C. Blood polyamine levels were measured in 108 patients with genitourinary cancers, 29 patients with benign prostatic hypertrophy, 18 patients with benign urological diseases and 25 normal subjects. Although polyamines were not significantly elevated in the low stage of cancer, elevation was observed at a high stage of malignancy. These results indicate that the determination of total polyamines may be useful to determine biochemically the malignancy of cancers.     

Pineal metastatic tumor from lung cancer initially caused by neurological abnormalities of pineal body tumor

A rare case is reported of pineal metastasis from lung cancer initially caused by neurological abnormalities of pineal tumor. A 70-year-old female suffering from headache and deterioration of consciousness for 1 week was admitted. She also had a tumor on both sides of her neck. On admission, neurological examination revealed disturbance of upward gaze, and CT scans showed hydrocephalus and pineal tumor. The tumor was seen as a slightly high density mass on non-contrast CT, and was homogeneously enhanced after administration of contrast material. Right V-P shunt and excision of the left neck tumor were performed at the same time. Pathological diagnosis of neck tumor was undifferentiated carcinoma metastasized to cervical lymph nodes. Extensive study was made, by bronchial fiberscope and biopsy, in order to find the origin of the malignancy and disclosed a small cell lung cancer of left lower lobe. The patient took radiation therapy for both the whole brain (60 Gy) and for the bilateral cervical regions (45 Gy). Two courses of chemotherapy using CDDP, ADR, VCR and CY were administered. Both the neck and the pineal tumors were markedly reduced in size at the termination of radiation therapy. However, she was readmitted 3 months later because of dyspnea. Chest X-P revealed enlargement of the left-lung tumor. She died on April 22, 1987. General autopsy disclosed invasive enlargement of left lung cancer, however, no remote metastasis was found. Examination of pineal region showed only necrotic pineal tissue, and no tumor cell was seen in either macroscopic or microscopic study.(ABSTRACT TRUNCATED AT 250 WORDS)     

Use of the subcutaneously based nasolabial flap in lower eyelid reconstruction.

A 54-year-old male had a history of approximately 18 months, with a diagnostically proven squamous cell carcinoma of the lower left eyelid. The full-thickness subtotal defect was reconstructed with the Hughes procedure (tarsoconjunctival flap) combined with a subcutaneously based nasolabial flap for skin coverage. To our knowledge, the use of the subcutaneous based nasolabial flap in this context has not been described previously. Use of the nasolabial flap may be considered for eyelid reconstruction.     

Effect of granulocyte colony-stimulating factor treatment at a low dose but for a long duration in patients with coronary heart disease.

BACKGROUND: In animal models, granulocyte colony-stimulating factor (G-CSF) improves post-infarct cardiac function. However, in pilot studies involving patients with angina and acute myocardial infarction (AMI), G-CSF at a high dose frequently induced coronary occlusion or restenosis, but those at a low dose showed no significant beneficial effect. We hypothesized that a low dose but long duration of G-CSF will have a beneficial effect without serious complications to patients with coronary heart disease. METHODS AND RESULTS: Forty-six patients with angina or AMI were randomly assigned into G-CSF and non-G-CSF control groups, respectively. Recombinant G-CSF was subcutaneously injected once a day for 10 days. The leukocyte counts in the peripheral blood were controlled at approximately 30,000/microl. One month later, a Thallium-201 single photon emission computed tomography revealed the increased percentage uptake and the reduced extent and severity scores in the G-CSF angina group. In the G-CSF AMI group, the curve between the ejection fraction and peak creatine kinase shifted significantly upward, compared with that of the non-G-CSF AMI group. Serious complications were not observed during the 6 months of observation. CONCLUSIONS: A low dose but long duration of G-CSF treatment may have a beneficial effect without any serious complications in patients with coronary heart disease.     

Carcinoembryonic antigen-like activity in gastric juice and plasma in patients with gastric disorders

Carcinoembryonic antigen (CEA)-like activity in gastric juice and plasma was examined in patients with gastric disease. There was no statistical difference in plasma CEA in normal subjects and in patients with benign gastric disease, early gastric cancer and advanced gastric cancer. However, four patients with advanced gastric cancer, one with stage III and three with stage IV disease had a very high plasma CEA level. There were significant differences in CEA-like activity in gastric juice in patients with benign gastric disease and early gastric cancer (p <0.01) and patients with benign and advanced gastric cancer (p <0.001). These results suggest that measurement of CEA-like activity in gastric juice is a useful adjunct to the diagnosis of early malignant changes in the stomach.     

Electron microscopic observation of scirrhous carcinoma of the stomach.

Electron microscopic findings obtained from seven scirrhous carcinomas of the stomach were analyzed dividing each carcinoma into superficial, deep, and peripheral parts. Proliferation of collagen fibrils, disappearance of plasma membranes, and extracellular release of cell organellae of cancer cells were considered to be peculiar findings to this type of cancer. These phenomena were observed frequently at the deep part of the cancer, but rarely at the peripheral and superficial parts. Replacement of damaged cells by the proliferated collagen fibrils at the central area of the cancer and disconnection of cancer cells from scirrhous lesion at the peripheral part were considered to contribute to the biological behaviour of this carcinoma.     

Clinical application of Hobel's high-risk pregnancy scoring system

Hobel's high-risk pregnancy screening scoring system was applied to 1,000 deliveries prospectively to test the validity of the screening system. Our results showed that the incidence of high-risk neonates increased significantly as the risk scores during the prenatal and intrapartum periods increased. In this series, 57.7% of the patients belonged to the low-low risk group and 9.8% was classified as the high-high risk group. The incidence of high-risk neonates in the low-low risk group was 13.5% whereas it was 32.0% in the high-high risk group. Further, maternal hypocapnia during delivery was found to be closely related to the incidence of neonatal hyperbilirubinemia in this series and proper management of maternal ventilations during delivery could reduce the incidence of neonatal hyperbilirubinemia.     

Long-term prognosis of esophageal variceal cases treated with injection sclerotherapy

One hundred fifty-two patients with esophageal varices underwent a total of 485 injection sclerotherapy procedures (mean, 3.2 times per each case). During 5 years of observation, 20 cases (13.2%) died following injection sclerotherapy. The 3-year survival rates, based on the Kaplan-Meier method, were 42% for emergency cases, 75% for elective cases and 90% for prophylactic cases. Significant differences (P less than 0.05) by the generalized Wilcoxon test were observed in the survival rates between emergency cases and prophylactic cases, and also between elective cases and prophylactic cases. Two cases (8.6%) of failure to control acute hemostasis were experienced. Twenty cases of bleeding after sclerotherapy were experienced, and 8 died of bleeding. The three-year bleeding rate according to the Kaplan-Meier method was 59% for emergency cases, 25% for elective cases and 7% for prophylactic cases. A significant difference (P less than 0.05) by the generalized Wilcoxon test was observed in the bleeding rate between elective cases and prophylactic cases. Non-bleeding rate (100%-bleeding rate) after sclerotherapy showed almost the same values as the survival rate. These results indicate that upper digestive tract hemorrhage influences the prognosis of patients after sclerotherapy.