A Clinical Study on Colitis Found during Total Colonoscopy Screening for Colorectal Cancer

Abstract: Colitis was found in 302 out of 5803 patients (5.2%) who underwent colonoscopy for the first time. Unclassified colitis (with slight edema, hemorrhage etc.) accounted for 89.1 % of these cases. Most of the colitis (93 cases, 40.1 %) was found to affect the sigmoid colon, followed, in order of decreasing frequency, by the rectum, cecum, transverse colon, descending colon and ascending colon. A comparison of the percentage revealed that of colitis found in two groups which were given different pre-treatments, 80 out of 3280 cases (2.4%) were found among those examinees pre-treated by the modified Brown method (B-method), while 152 out of 2513 cases (6.0%) were found in those pre-treated by the PEG oral lavage method (P- method). About 40% of the diagnosed colitis cases were free from symptoms (diarrhea, abdominal pain, etc.); the results of the guaiac test on their stool samples were negative. We hypothesized that, in these cases, signs of colitis were actually pretreatment-induced artifacts. No significant differences were found among groups with regard to sex and age, nor was the fraction of colitis cases represented by artificial colitis significantly different between pre-treatment groups.     

Oral contraceptive-dependent growth of focal nodular hyperplasia

Abstract A 22 year old woman was incidentally found to have a hepatic small haemangioma-like mass, measuring 1.4 cm in diameter, by an ultrasonographic examination. The mass demonstrated no change in size or appearance for 6 months until the patient began to take oral contraceptives. Eventually, the mass increased to 2.0 cm in diameter after using oral contraceptives for 6 months. A histological examination suggested the mass to be typical focal nodular hyperplasia, and not hepatic adenoma. There was no further change in either size or appearance in the ensuing 1 year after the discontinuation of oral contraceptives.     

Adiponectin is increased and correlated with the degree of proteinuria, but plasma leptin is not changed in patients with chronic glomerulonephritis

Aim:   Altered regulation of adiponectin and leptin may be relevant to endothelial dysfunction and cardiovascular complications in patients with chronic glomerulonephritis.
Methods:   The relationship between the levels of plasma adiponectin, leptin and proteinuria, glomerular filtration rate and metabolic risk factors was investigated in 38 patients with chronic glomerulonephritis.
Results:   Plasma adiponectin was much higher in patients with heavy proteinuria (38.8 ± 27.8 µg/mL) than in patients with mild proteinuria (13.3 ± 5.1 µg/mL, P  < 0.001) and with moderate proteinuria (18.1 ± 8.0 µg/mL, P  < 0.01). The levels of serum leptin were not changed among these groups. Proteinuria and lipoprotein(a) were a strong and direct correlate of plasma adiponectin ( r  = 0.75, P  < 0.0001), while serum albumin and the glomerular filtration rate correlated inversely with this protein ( r  = −0.56, P  = 0.0002; r  = 0.38, P  = 0.02). Body mass index and triglyceride were direct correlates ( r  = 0.37, P  = 0.02 and r  = 0.37, P  = 0.02, respectively) of plasma leptin in patients with glomerulonephritis.
Conclusions:   Plasma adiponectin but not plasma leptin levels correlate with proteinuria in patients with chronic glomerulonephritis.     

Nonuniformity of AH Intervals During Stimulation at Different Left Atrial Sites

Studies in humans have found left atrial stimulation via the coronary sinus (CS) to elicit significantly shorter atrium-His (AH) intervals as compared to right atrial stimulation, but whether pacing at dijferent left atrial sites (anterior vs posterior left atrium, i.e., far distal vs proximal CSJ affects the AH interval has not been studied. Hence, in 22 patients, we compared the effects of stimulation from various atriai sites, including anterior high right atrium (HRA), distal CS, mid-CS, and proximal CS, on; stimulus-atrium (SA), AH, and stimuIus-His intervals on the His bundle electrogram. Paced cycle length differed for each patient (range 900–350 msec, mean 532 ± 140 msec), but conduction intervals from different atrial sites were compared using identical cycle length in each patient. The mean SA intervals were 34 ± 10 msec, 57 ± 10 msec, 44 ± 11 msec, and 32 ± 8 msec with stimulation, respectively, from HRA, distal CS, mid-CS. and proximal CS (each significantly different except for HRA vs proximal CSJ. The mean AH intervals were 123 ± 23 msec, 104 ± 28 msec, 95 ± 15 msec, and 90 ± 18 msec with stimulation, respectively, from HRA, distal CS, mid-CS, and proximal CS (each significantly different except for mid-CS vs proximal CSJ. In 13 patients, the discrepancy in AH intervals during distal versus proximal CS stimulation was > 15 msec; in 9 patients this difference was only < 10 msec, considered within the range of measurement error. Thus, in a significant portion of patients, discrepant AH intervals were demonstrated during stimulation from the distal versus proximal CS. These previously undescribed observations suggest that electrophysiological studies on atrioventricular nodal conduction that involve left atrial stimulation must take into account actual location of the stimulation site (anterior or posterior) in order to properly interpret the findings.     

Differences in Fine Mucosal Structure between Superficial Spreading Carcinoma and Non-neoplastic Bile Duct Mucosa Detected by Percutaneous Transhepatic Cholangioscopy

Abstract: Papillogranular mucosa is reportedly characteristic of superficial spreading bile duct carcinoma, but may also be seen in non-neoplastic ductal tissue. This study was designed to clarify differences between these conditions by examining fine mucosal structure with percutaneous transhepatic cholangioscopy (PTCS) and methylene blue (MB) staining. Sixty-three patients with malignant bile duct stenoses and 11 with benign bile duct disorders were examined by PTCS and the relationship between fine mucosal structure and histology was defined using endoscopic photographs and biopsy samples. Papillogranular mucosal samples contained superficial spreading carcinoma significantly more often than smooth mucosal samples (p<0.0001). Papillogranular mucosa was classified by fine structure into four types : regular papillogranular, nodular, finely reticulogranular and highly papillary. The latter three types were associated with superficial spreading carcinoma significantly more often than with non-neoplastic mucosa (p<0.05). However, regular papillogranular mucosa was associated with both neoplastic and non-neoplastic tissue. All papillogranular mucosal samples not stained with MB contained superficial spreading carcinoma. In 19% of papillogranular mucosa samples fine mucosal structure was identified by routine observation, while in 84% fine structure was determined by a combination of routine observation and MB staining. In conclusion, nodular, finely reticulogranular and highly papillary forms of papillogranular mucosa, as well as papillogranular mucosa which does not stain with MB, are characteristic of superficial spreading carcinoma. The combination of routine observation and MB staining is useful for analyzing the fine mucosal structure of papillogranular mucosa. However, meticulous observation is needed to diagnose superficial spreading carcinoma in regular papillogranular mucosa.     

Rapid detection of the fluoroquinolone resistance-associated ParC mutation in Neisseria gonorrhoeae using TaqMan probes

BACKGROUNDS: In fluoroquinolone-resistant Neisseria gonorrhoeae, the amino acid mutations in the fluoroquinolone-resistant determining region (QRDR) of the parC gene are an important factor. The aim of the present study was to develop a rapid detection method of a serine 88 to proline substitution in parC which we previously showed as having significantly higher fluoroquinolone minimal inhibitory concentrations (MIC) using the TaqMan discrimination system. METHODS: We extracted DNA from 90 urine or urethral swab samples obtained from male patients with urethritis caused by N. gonorrhoeae. After DNA extraction, they were subjected to real-time polymerase chain reaction (PCR) using a TaqMan discrimination system and compared with the results of conventional DNA sequencing. RESULTS: Of the 90 samples, the TaqMan technique result showed 13 samples that were classified as having a serine 88 to proline mutation in parC, and 77 samples that did not have a serine 88 to proline mutation in parC. The classifications of all samples completely corresponded to those determined by conventional DNA sequencing. We also found that N. gonorrhoeae with a serine 88 to proline mutation in parC have a significantly higher MIC to ciprofloxacin than that without a serine 88 to proline mutant in parC. CONCLUSIONS: The present genotyping method of real-time PCR using a TaqMan discrimination system could be applied to the rapid detection of a serine 88 to proline amino acid mutation in parC of N. gonorrhoeae. This point mutation is significant for the determination of fluoruquinolone resistance. This rapid detection system may lead to the prevention of use of noneffective antimicrobial agents and a decrease of resistant strains.     

Establishment of embryonic stem cells secreting human factor VIII for cell-based treatment of hemophilia A

Summary.  Background:  Hemophilia A is an X-chromosome-linked recessive bleeding disorder resulting from an F8 gene abnormality. Although various gene therapies have been attempted with the aim of eliminating the need for factor VIII replacement therapy, obstacles to their clinical application remain. Objectives:  We evaluated whether embryonic stem (ES) cells with a tetracycline-inducible system could secrete human FVIII. Methods and results:  We found that embryoid bodies (EBs) developed under conditions promoting liver differentiation efficiently secreted human FVIII after doxycycline induction. Moreover, use of a B-domain variant F8 cDNA (226aa/N6) dramatically enhanced FVIII secretion. Sorting based on green fluorescent protein (GFP)–brachyury (Bry) and c-kit revealed that GFP–Bry⁺/c-kit⁺ cells during EB differentiation with serum contain an endoderm progenitor population. When GFP–Bry⁺/c-kit⁺ cells were cultured under the liver cell-promoting conditions, these cells secreted FVIII more efficiently than other populations tested. Conclusion:  Our findings suggest the potential for future development of an effective ES cell-based approach to treating hemophilia A.     

Progress report on phase I/II clinical trial of Ad-OC-TK plus VAL therapy for metastatic or locally recurrent prostate cancer: Initial experience at Kobe University

There is no effective therapy for hormone-refractory prostate cancer and a novel therapeutic modality, such as a gene therapy, should be actively pursued. Previously, Gardner and Chung conducted a phase I clinical trial of Ad-OC-TK (recombinant adenoviral vector containing osteocalcin promoter-driven herpes simplex virus thymidine kinase gene) plus VAL (valacyclovir) for the treatment of hormone-refractory prostate cancer at the University of Virginia. We report on our ongoing phase I/II clinical trial of Ad-OC-TK plus VAL for the treatment of advanced prostate cancer at the Kobe University Hospital, Japan.     

Clinical outcomes of laparoscopic adrenalectomy according to tumor size

Objectives: In order to evaluate the indication and usefulness of laparoscopic adrenalectomy, clinical outcomes of laparoscopic adrenalectomy for patients with adrenal tumors were examined. Whether tumor size affects surgical outcome was analysed, along with the long-term clinical outcome for these patients.
Patients and methods: A total of 63 patients with adrenal tumor underwent laparoscopic adrenalectomy in our institute between 1999 and 2003. A laparoscopic transperitoneal approach was used in all cases. Underlying pathologies comprised Cushing syndrome ( n  = 12), pheochromocytoma ( n  = 13), primary aldosteronism ( n  = 21), non-functioning adenoma ( n  = 12) and others ( n  = 5).
Results: No open conversion was performed. Mean operative duration was 239 min, and mean estimated blood loss was 134 mL. Tumor diameter was significantly smaller for primary aldosteronism than for Cushing syndrome, which in turn was significantly smaller than for adrenocorticotropic hormone-independent macronodular hyperplasia (AIMAH). No significant differences in surgical outcome and postoperative recovery were noted between large (≥5 cm) and small (<5 cm) tumors. Long-term clinical outcome was better for patients with pheochromocytoma or primary aldosteronism than for patients with Cushing syndrome.
Conclusions: Laparoscopic adrenalectomy for benign tumor offers excellent surgical outcomes and convalescence. This is true for both small and large tumors.