Imaging diagnosis of ruptured site in hepatocellular carcinoma

Rupture causes frequently the patients with HCC to death. Then it is important to investigate ruptured site of HCC in order to stop bleeding effectively and safely by emergent TAE without causing liver failure. We evaluate the usefulness of 3 major imaging method, such as US, CT and angiography in our 18 cases of HCC. In ultrasonography, ruptured site was shown as the high echoic area localized around the tumor in 4/15 cases (26.7%). In computed tomography of rapid scanning, it was shown as the intraperitoneal high density area around the tumor in 3/18 cases (16.7%). And lipiodol CT showed the characteristic leakage in the abdominal cavity. In angiography, it was shown as the extravasation of contrast material only in 2/13 cases (15.4%). In the results, it was possible to diagnose the ruptured site in 8/18 cases (44.4%) by using these procedures. Diagnosis of ruptured site will make it possible to reduce the frequency of hepatic failure caused by emergent TAE.     

Clinical characteristics of unstable angina in 162 consecutive cases

We surveyed the clinical characteristics, treatment, and prognosis of 162 patients with unstable angina, who were admitted to our center between 1985 and 1987. There were 112 males and 50 females, with a mean age of 65 years. The clinical characteristics according to the American Heart Association classification were new angina of effort in 21%, changing pattern in 61%, and new angina at rest in 18% of the patients. ECG recordings during attacks of angina were obtained in 70%, and ST elevation was detected in 11%, ST depression in 54%, and T wave abnormality in 5%. Coronary arteriography performed in 42% of the patients revealed single vessel lesion in 21%, two vessel lesion in 10%, three vessel lesion in 5%, and left main trunk lesion in 3% of the patients. Seventy-seven percent of the patients were controlled by medical therapy, including nitrates, calcium antagonists, and, in some cases, beta blockades. Three percent of the patients were controlled with intra aortic balloon pumping in addition to medical therapy. Coronary artery bypass graft surgery (CABG) was performed in 6% of the patients. Since 1987, percutaneous transluminal angioplasty (PTCA) was introduced in our center and PTCA was performed in 9 patients (6%). Restenosis of the dilated portions of the coronary artery was observed and PTCA was again performed in 2 of 9 patients (22%). All patients who received CABG or PTCA survived and have been free from angina or myocardial infarction. Non-fatal myocardial infarction occurred in 10 cases (5.6%) and fatal infarction occurred in one patient (0.6%).     

Epithelium-lined cyst of the pretectal region: case report and electron microscope study

Ultrastructural findings of an epithelium-lined cyst in the left pretectal region are reported. A 38-year-old woman developed a sensory disturbance on her right side and blurring of vision. Computed tomography scans and magnetic resonance images disclosed a round cystic lesion in the left pretectum. Light microscopically, the cyst was found to be lined by a single layer of cuboidal epithelial cells. Electron microscope examination revealed that the epithelial cells of the cyst possessed clear nuclei, abundant tonofilaments, and glycogen granules, featured as well as the usual organellae. The free surface of the epithelial cells had numerous finger-like microvilli with coating materials. These cells were interconnected by well-developed desmosomes and interdigitations, and also possessed basal lamina materials on the basal surface. These cytological features suggest a heterogenous origin of the cells rather than a neuroepithelial one.     

Subcellular localization of the low density lipoprotein receptor-related protein (α2-macroglobulin receptor) in human brain

The subcellular localization of the α₂-macroglobulin receptor, also known as the low density lipoprotein receptor-related protein (LRP), was studied in postmortem human brain tissue by light and electron microscopic immunocytochemistry. A specific monoclonal antibody (A2MR2) against the extracellular α-chain of the molecule was utilized. Light microscopically, LRP was detected strongly in neurons, weakly in some glial cells and discontinuously along capillary membranes. At the electron microscopic level, positive reaction products were found to be associated with plasma membranes, ribosomes, lysosomes and lipofuscin granules of neurons, glial cells and pericytes. The results suggest that LRP may have a function, particularly in neurons, of receptor-mediated endocytosis with subsequent lysosomal uptake and degradation of ligands such a α₂-macroglobulin proteinase complexes and apolipoprotein E.     

Prostaglandin E2 protects cultured cortical neurons against receptor-mediated glutamate cytotoxicity

The effects of prostaglandin (PG) E₂ on glutamate-induced cytotoxicity were examined using primary cultures of rat cortical neurons. The cell viability was significantly reduced when cultures were briefly exposed to either glutamate or (NMDA) then incubated with normal medium for 1 h. Similar cytotoxicity was observed with the brief application of ionomycin, a calcium ionophore, and S-nitrosocysteine, a nitric oxide (NO)-generating agent. PGE₂ at concentrations of 0.01–1 μM dose-dependently ameliorated the glutamate-induced cytotoxicity. PGE₁, butaprost, an EP₂ receptor agonist, and 8-bromo-cAMP were also effective in protecting cultures against glutamate cytotoxicity. By contrast, neither 17-phenyl-ω-trinor-PGE₂, an EP₁ receptor agonist, nor M & B 28767, an EP₃ receptor agonist, affected glutamate-induced cytotoxicity. NMDA-induced cytotoxicity was ameliorated by PGE₂, butaprost, MK-801, , a NO synthase inhibitor, and hemoglobin, which binds NO. These agents excluding MK-801 ameliorated the ionomycin-induced cytotoxicity. The cytotoxicity induced by S-nitrosocysteine was prevented only by hemoglobin but not by the other agents including PGE₂. These findings indicate that PGE₂ protects cultured cortical neurons against NMDA receptor-mediated glutamate neurotoxicity via EP₂ receptors. EP₂ receptor stimulation may suppress a step in NO formation triggered by Ca²⁺-influx through NMDA receptors.     

A case of extramedullary plasmacytoma of the spleen

A case of extramedullary plasmacytoma of the spleen in a 39 years-old man was reported. The tumor occupied almost of the spleen and extended to the transverse colon. 67Ga scintigraphy and MRI, particularly T 2-weighted image were useful in diagnosis of the localization.     

Emergency Endografting for Spontaneous Thoracic Aortic Rupture

Spontaneous rupture of the thoracic aorta is rare. We present a 76-year-old man who developed spontaneous rupture of the aortic arch associated with massive periaortic hematoma and hypovolemic shock. Because the site of rupture could not be identified, emergency hybrid endovascular aortic repair to shield a long segment of the aorta was performed according to the extent and density of periaortic hematoma on axial CT scans. His blood pressure improved just after deployment of the endograft. Rapid diagnosis by CT and prompt control of aortic hemorrhage by endografting salvaged this patient. Three-dimensional (3D) volume-rendered CT images are useful for identifying the site of aortic rupture, but may not be available in an emergency.     

The distribution of eGFR by age in a community-based healthy population: the Japan specific health checkups study (J-SHC study)

Clinical and Experimental Nephrology - Renal function gradually declines with age. However, the association between changes in renal function and healthy aging has not been determined. This study...