Longitudinal change in muscle and fat thickness in children and adolescents with cerebral palsy

Aim  In a prospective, longitudinal study, we investigated the influence of the severity of motor impairment on changes in body characteristics in children with moderate-to-severe cerebral palsy (CP).
Method  Twenty-six single children and adolescents (15 females, 11 males; mean age 10y 6mo, SD 3y 3mo) with spastic (quadriplegia, hemiplegia, or diplegia), athetotic, or hypotonic CP at Gross Motor Function Classification System (GMFCS) levels III to V participated. They were categorized into moderate (GMFCS levels III or IV, n =11) and severe (GMFCS level V, n =15) groups. Muscle thickness of the quadriceps femoris (MTQ) and fat thickness of the anterior thigh (FTA) measured using ultrasound images, together with weight and height, were obtained at annual measurements over 3 years.
Results  Significant increases in all variables were found in both groups. The areas under the curve (AUCs: an index of the gain) for weight, MTQ, and FTA were significantly higher in the moderate group. The AUC for weight, adjusted for height, was significantly correlated with the AUC for MTQ in the moderate group, and with the AUC for FTA in the severe group.
Interpretation  Weight gain in children with severe CP does not necessarily reflect muscle growth.     

真菌胞内蛋白质提取方法的建立

目的：研究不同的提取方法对白假丝酵母和茄病镰刀菌胞内蛋白质浓度、种类及数量的影响,为建立一种稳定可靠的真菌胞内蛋白质提取方法提供依据。方法：分别以白假丝酵母菌和茄病镰刀菌为研究对象,培养时间为36、48和72 h,超声波工作时间为20 s、3 min、5 min,10 min,超声波功率为332.5和475.0 W,通过蛋白质浓度检测和SDS-PAGE蛋白质电泳分析,比较不同条件下提取的蛋白质浓度、种类及数量,观察不同因素对蛋白质提取效果的影响。结果：2株真菌均在培养36 h时提取胞内蛋白质的浓度最大,白假丝酵母在功率332.5 W、超声3 min时得到胞内蛋白质的数量和种类最多,茄病镰刀菌在功率332.5 W、超声10 min时得到蛋白质的数量和种类最多。结论：使用超声波法与玻璃珠研磨法结合提取胞内蛋白质,从菌株的培养时间、超声波工作时间和功率3方面建立了真菌胞内蛋白质的最佳提取方法。     

Micropapillary bladder cancer

A characteristic clinical course of a patient with micropapillary bladder cancer, a rare histological variant with high metastatic potential, is presented. An 80-year-old woman had locally advanced high-grade bladder cancer with a focal micropapillary variant identified which was treated with intra-arterial chemotherapy with radiation therapy. Standard follow-ups involving cystoscopy with cold-cup biopsies and computed tomography could not detail the bladder carcinoma; however, the patient died of carcinomatosis 20 months after treatment. At autopsy, carcinomas proliferated under benign mucosa and infiltrated diffusely in the retro peritoneum. This behavior differs from the normal pattern of invasive transitional cell carcinoma, which usually proliferates forming a mass lesion. Thus, it may be difficult to detect micropapillary bladder cancer by computed tomography which demonstrates only increased tissue density in retroperitoneal fascia; therefore, care should be taken in the follow-up of micropapillary bladder cancer.     

Phyllodes tumor of the prostate: Recurrent obstructive symptom and stromal proliferative activity

We report the case of a 59-year-old man with a metachronous development of phyllodes tumor and adenocarcinoma of the prostate. He complained of urinary obstruction and transurethral resections of the prostate (TUR-P) had been performed six times in 10 years. Microscopic examination showed cystically dilated glands consisting of bizarre cells with pleomorphic, hyperchromatic nuclei in the stroma at the sixth TUR-P. Radical prostatectomy was performed against recurrences and adenocarcinoma was incidentally detected. Apparent up-regulation of proliferative nuclear antigens (PCNA), but not p53, was observed in the prostatectomy specimen by Western blotting. Active proliferation of stromal cells is considered to have caused the recurrent obstructive symptom.     

Laparoscopic nephropexy: Treatment outcome and quality of life

BACKGROUND: The recent introduction of laparoscopic procedures has markedly altered urological surgery. Laparoscopic nephropexy has attracted the attention of urologists as a treatment for nephroptosis. Herein, we describe our experiences and quality-of-life outcome of laparoscopic nephropexy and discuss its indications and surgical techniques. METHODS: From May 1998 to February 2002, six female patients, ranging in age from 20 to 64 years (median age 39.8 years), with symptomatic nephroptosis underwent laparoscopic nephropexy. Mean preoperative downward kidney displacement was 2.25 vertebral bodies (range 2-2.5) and all affected kidneys were tilted at orthostasis. One patient underwent nephropexy through the transperitoneal approach and the remaining patients underwent nephropexy through the retroperitoneal approach. To evaluate surgical results, postoperative follow-up interview (pain visual analog scale and the short-form 36 (SF-36) health survey questionnaire) and objective examinations were performed. RESULTS: All procedures were accomplished without complication. Postoperative intravenous pyelography correctly confirmed fixed kidney in both supine and erect positions. All patients reported an improvement of symptoms approximately 1 month after nephropexy and no symptoms have recurred during the follow-up period (range 6.3-50.7 months). On the SF-36, two domains, including role limitations due to emotional problems (RE) and mental health (MH), exhibited significant improvement postoperatively (P = 0.0405 and P = 0.0351, respectively). CONCLUSIONS: Laparoscopic, in particular retroperitoneoscopic, nephropexy yields excellent outcomes and greatly improves general health-related quality of life, particularly mental status, as a minimally invasive treatment for symptomatic nephroptosis.     

Interstitial laser coagulation for management of benign prostatic hyperplasia: Long-term follow-up

AIM: We evaluated the long-term results of transurethral interstitial laser coagulation in the treatment of benign prostatic hyperplasia (BPH) with up to 9 years of follow up at the Kurashiki Central Hospital and determined the patient characteristics that predict a favorable outcome. METHODS: From December 1993 to May 1997, a total of 82 patients were enrolled in the present study. Subjective and objective voiding parameters were collected from medical records and a self-administered questionnaire was sent to the patients. Kaplan-Meier plots were constructed to assess the risk of retreatment. RESULTS: The mean follow-up period was 48.4 months (range, 3-108 months). A total of 59 patients (72%) did not need any additional treatment at 12 months and 30 patients (37%) did not require additional treatment during the entire follow-up period. A total of 29 patients (35%) were retreated during follow-up. Transurethral prostate resection (TURP) was performed in 18 patients (22%). The remaining 11 patients (13%) were offered additional pharmacotherapy. The minimum and median retreatment-free durations were 3 and 14 months, respectively. Seven patients died and 17 were lost to follow-up. Men aged 71 years or older had greater likelihood of requiring retreatment than those younger than 71 years (P = 0.0397). No significant differences were noted in the other baseline characteristics. Among postoperative parameters, a rate of decrease of the International Prostate Symptom Score of the patient of lower than 60% and a rate of decrease in patient quality of life of lower than 50% at 3 months were associated with greater likelihood of retreatment (P = 0.0083 and P = 0.0006, respectively). CONCLUSIONS: Interstitial laser coagulation is effective for the treatment of BPH. Good long-term results and an acceptably low retreatment rate render this modality an effective alternative to TURP, especially for younger patients. Short-term improvement of subjective symptoms was predictive of favorable long-term outcome.     

Newly Developed Endoscopic Resection Technique for Colorectal Tumors

We applied a newly developed endoscopic resection technique for a rectal mucosal cancer of 4.2 cm. This method resulted in a curable treatment and provided precise information for histological examinations. This technique, using IT‐knife, may involve the risk of bleeding and perforation compared with conventional methods. Further improvements are needed to make this technique safer and more reliable for a standard endoscopic method for large colorectal tumors.     

Influence of thrombopoietin on platelet activation in myeloproliferative disorders

Although thrombopoietin itself does not influence platelet aggregation, it enhances platelet activation in response to certain agonists. We evaluated the effects of thrombopoietin on platelet activation using platelet-rich plasma from 16 patients with myeloproliferative disorders (MPD group) and 16 healthy volunteers (control group). Preincubation with thrombopoietin significantly enhanced platelet aggregation stimulated by ADP, collagen, or epinephrine in the MPD group as well as the control group. However, aggregation induced by 3 μ M ADP or 16 μ M epinephrine showed significantly less augmentation by thrombopoietin in the MPD group than in the control group. Thrombopoietin significantly shortened the lag time between the addition of 3 μ M ADP or 16 μ M epinephrine and initiation of secondary aggregation and the lag time between addition of 2 μg/ml collagen and initiation of aggregation in both groups. When platelet-rich plasma was used without adjustment of the platelet count, thrombopoietin itself induced aggregation in two patients. Hypoaggregation after addition of 0.5 μg/ml collagen was observed in seven out of nine patients with normal thrombopoietin levels and only one of six patients with high levels ( P =0.04). Enhancement of 0.5 μg/ml collagen-induced aggregation by thrombopoietin was seen in five out of nine patients with normal thrombopoietin levels and none of the six patients with elevated levels ( P =0.04). These results indicate that platelet activation by certain agonists is enhanced by thrombopoietin in patients with these diseases as well as in normal controls and that the serum thrombopoietin level may regulate the function of circulating platelets in vivo .     

Expression of erythroid-specific genes in acute megakaryoblastic leukaemia and transient myeloproliferative disorder in Down's syndrome

Summary. Acute megakaryoblastic leukaemia (M7) and transient myeloproliferative disorder in Down's syndrome (TMD) are characterized by rapid growth of abnormal blast cells which express megakaryocytic markers. To clarify properties of the blast cells in M7 and TMD cases, we examined erythroid markers expression in blasts from six cases with M7 and seven cases with TMD in this study. Erythroid-specific mRNAs encoding 7-globin and erythroid 6-aminolevulinate synthase were found to be expressed in blasts from most of these cases, indicating that majorities of the blasts in M7 and TMD cases have erythroid and megakaryocytic phenotypes. We also found that mRNAs encoding GATA-1 and GATA-2 are expressed in all these cases. These results suggest that M7 blasts and TMD blasts correspond to the erythroid/megakaryocytic bipotential progenitor cells.     

Impact of radical perineal prostatectomy on urinary continence and quality of life: A longitudinal study of Japanese patients

AIM: We used self-completed questionnaires to obtain a longitudinal assessment of urinary continence and urinary, bowel, and sexual domain-related quality of life (QOL) in Japanese patients undergoing radical perineal prostatectomy (RPP). METHODS: A total of 41 Japanese patients with a median age of 69 years who underwent RPP between February 2002 and February 2004 were included in the study. We measured QOL by the University of California, Los Angeles, Prostate Cancer Index (UCLA-PCI) and assessed urinary continence on the basis of three different definitions of continence. The International Prostate Symptom Score (I-PSS) was also included to evaluate lower urinary tract symptoms (LUTS). RESULTS: When urinary continence was de fi ned as none, one, or two protective pads per day, 100%, 73%, 94%, 97%, or 100% of the patients were continent before, and 1, 3, 6, and 12 months after, RPP, respectively. When it was de fi ned as total control or occasional dribbling, the corresponding values were 97%, 70%, 84%, 94%, and 97%. Urinary function returned to the preoperative baseline level by 6 months postoperatively and scores for urinary bother had significantly surpassed the baseline by 12 months (P = 0.043). The I-PSS was significantly improved (P = 0.014), with a mean 4.7-unit decrease. Sexual function worsened significantly after surgery, and its recovery was less favorable. No significant change was observed in scores for bowel function or bowel bother. CONCLUSIONS: The majority of patients who undergo RPP rapidly regain urinary continence and QOL within 3-6 months. RPP has a favorable impact on LUTS.