Interventional radiology for recurrent cancer]

The indications for the reoperative treatment for postoperative recurrence of cancer in the field of gastroenterology are usually limited. Interventional radiology (IVR), which is less invasive and effectively enhances the quality of life, will play an important role in the treatment of patients with postoperative recurrent cancer. This paper evaluate IVR as a therapeutic strategy for postoperative recurrent cancer in gastroenterology based on our experience. Metallic stents have proven useful for stenosis of the alimentary tract due to recurrence after surgery for esophageal or gastric cancer and for jejuno-biliary anastomotic stenosis caused by postoperative recurrent bile duct cancer. Segmental Lipiodol TAE is more effective and result in better cumulative survival rates than conventional TAE in the treatment of postoperative recurrence of hepatoma.     

I.v. lidocaine worsens histamine-induced bronchoconstriction in dogs

We have assessed the effect of lidocaine (lignocaine) on histamine- induced bronchoconstriction by direct visualization with a superfine fibreoptic bronchoscope. Seven mongrel dogs were anaesthetized with pentobarbital (pentobarbitone) 30 mg kg-1 followed by 2 mg kg-1 h-1 and pancuronium 200 micrograms kg-1 h-1. The trachea was intubated with a tracheal tube containing a second lumen for insertion of a 2.2-mm fibreoptic bronchoscope. This allowed estimation of the bronchial cross- sectional area (BCA) of the third bronchial bifurcation of the right lung. We used NIH image, a public domain image processing and analysis program. Bronchoconstriction was produced with a bolus dose of histamine 10 micrograms kg-1 i.v. followed by continuous infusion of 500 micrograms kg-1 h-1. After 30 min the following i.v. doses of lidocaine were given: lidocaine 0 (saline), 0.01, 0.1, 1.0 and 10 mg kg- 1 at 10-min intervals. BCA was assessed 90 s after each dose. Arterial blood sampling was performed for measurement of plasma catecholamines. Lidocaine 1.0 and 10 mg kg-1 significantly reduced histamine-decreased BCA from 69.7 (SEM 4.1)% to 59.8 (7.3)% and 34.3 (6.8)%, respectively. Plasma concentrations of catecholamines decreased significantly after lidocaine 10 mg kg-1 i.v. In addition, there was a significant correlation between percentage decreases in plasma concentrations of epinephrine (adrenaline) and norepinephrine (noradrenaline) and reduction in %BCA (epinephrine-BCA, P < 0.01, r = 0.674; norepinephrine- BCA, P < 0.01, r = 0.510). This study suggests that i.v. lidocaine may exacerbate histamine-induced bronchoconstriction by a sympatholytic effect. This may have therapeutic implications for patients with acute asthma or anaphylactic shock who may become dependent on circulating catecholamines.      

Effects of Xenon on the Performance of Various Respiratory Flowmeters

Background: The anesthetic gas xenon has distinctly different physical properties compared with air, nitrous oxide, or oxygen. This led us to predict that xenon would affect the performance of commercially available flowmeters.

Methods: Flow was generated by an anesthesia ventilator connected to a lung simulator via a semiclosed breathing circuit. With the system filled with air or with various concentrations of xenon or nitrous oxide in a balance of oxygen, the tidal volume was measured with two rotating vanes, a Pitot tube, a variable-orifice flowmeter, and two constant-temperature hot-wire flowmeters.

Results: Although xenon minimally affected both rotating vane flowmeters, it caused the Pitot tube and the variable-orifice flowmeters to overread in proportion to the square root of the density of the gas mixture used (xenon is 4.6 times more dense than air). In contrast, the hot-wire anemometers underread with xenon; for example, their readings in the presence of 45% and 70% xenon were less than 10% of those displayed when air was used. Nitrous oxide minimally affected all the flowmeters except the variable-orifice device. The Pitot flowmeter was also affected, but only when its gas analyzer port was open to the ambient air so that it no longer corrected its readings for changes in gas composition. In these cases, nitrous oxide produced overreadings in the same manner as did xenon.     

Obesity affects expression of progesterone receptors and node metastasis of mammary carcinomas in postmenopausal women without a family history

Possible relationships between risk factors, such as obesity and a family history of breast cancer, and prognostic factors of mammary carcinomas were investigated by examining the body mass index of patients and the expression of estrogen (ER) and progesterone receptors (PgR), c-erbB-2 and p53, grade of histology, size of tumors and nodal status of mammary carcinomas. There was no significant difference in the body mass index of premenopausal patients either with or without a family history. For postmenopausal patients, the body mass index was significantly low in patients with a family history compared with patients without a family history. In premenopausal patients with or without a family history and in postmenopausal patients with a family history, there was no significant difference in the body mass index regardless of the mammary carcinoma prognostic factor, such as expression of ER, PgR, c-erbB-2 and p53, grade of histology, size of tumors and nodal status. However, in postmenopausal patients without a family history, body mass index was significantly high for patients with mammary carcinomas that had PgR expression and node metastasis. These results suggest that obesity may affect the PgR status and nodal status of mammary carcinomas in postmenopausal patients without a family history.     

A mechanism for shock following stomach rupture in the newborn

BACKGROUND: Stomach rupture often leads to shock and death within a short period, but the mechanism for this is not well-known. Shock may be due, in part, to endotoxin translocation and endotoxemia. METHODS: Sterile, endotoxin-free HCl (0.1 mol/L), with or without endotoxin-feeding, was injected intraperitoneally into 10-day-old rats, simulating stomach rupture in the newborn. The plasma endotoxin concentration was measured. Plasma glucose and lactate concentrations were monitored to assess physiologic response to endotoxemia and shock. RESULTS: Endotoxin feeding alone caused endotoxemia (0.49 +/- 0.12 ng/mL; P < 0.05) in 10-day-old rats, while plasma endotoxin concentration in controls was less than 0.04 ng/mL. However, the endotoxemia did not cause disruption of glucose regulation or death. Injection of HCl alone did not increase plasma endotoxin concentrations and did not alter glucose regulation. However, HCl injection into endotoxin-fed rats induced endotoxemia (211.1 +/- 70.5 ng/mL; P < 0.05), hypoglycemia, lactacidemia and mortality (45%; P < 0.05). CONCLUSION: Early development of shock following stomach rupture may be in part due to endotoxin translocation and endotoxemia.     

Detection of a novel DNA virus (TTV) sequence in peripheral blood mononuclear cells.

DNA sequences of a novel DNA virus (TTV) were examined in 81 peripheral blood mononuclear cell (PBMC) DNA samples from 48 children and 33 adults, 22 cord blood mononuclear cells (CBMC) DNA samples, and 7 autopsy liver tissue DNA samples by a hemi-nested polymerase chain reaction (PCR). The PCR was carried out using the published primers (NG059, NG061, NG063) to amplify TTV DNA sequences. The sequences were detected in 4 of 81 (5%) PBMC DNA samples, in none of 22 (0%) CBMC DNA samples, and in 2 of 7 (29%) liver tissue DNA samples by direct gel analysis. The PCR-amplified products were confirmed by direct sequencing. The sequencing showed considerable diversities, with differences of 0-55% in 6 TTV isolates, compared with the prototype sequence of TTV. These results suggest that TTV is a ubiquitous virus that produces asymptomatic infection in a large proportion of the general population without transfusion of blood-derived products. To our knowledge, this is the first report describing the detection of TTV DNA sequences in PBMCs.     

Histocompatibility antigens and alleles in Japanese haemophilia A patients with or without factor VIII antibodies

We carried out human leukocyte antigen (HLA)-A, B, Cw, DR and DQ serological typing and HLA-DQA1, DQB1, DRB1 and DPB1 genetic typing for 46 Japanese haemophilia A patients, including 20 who had developed an antibody to factor VIII. It appears that anti FVIII inhibitor formation is associated with the major histocompatibility complex in Japanese haemophilia A patients. Absence of HLA-A24 is a principal risk factor for inhibitor formation in Japanese haemophilia A patients. As supplemental risk factors, HLA-DR4.1, DQ4 and DQA1*0301=2 are positively associated with patients exhibiting inhibitor compared with normal subjects. This and previous studies show that the association between HLA antigens and the formation of inhibitor depends on race. Data of HLA typing may be useful for the recognition of groups at high risk for the possible formation of inhibitor among Japanese haemophilia A patients.