Effectiveness of prosthetic mandibular advancement for obstructive sleep apnea:Analysis by sleep position

Abstract Fifteen patients with obstructive sleep apnea were treated using prosthetic mandibular advancement (PMA). Each patient was evaluated in the supine and lateral decubitus positions with and without PMA. After PMA treatment, the mean intraesophageal pressure (Peso) in the supine position improved from -42.6 to -27.3 cmH₂O and the mean apnea + hypopnea index (AHI) decreased from 48.8/h to 23.7/h. The mean Peso in the lateral decubitus position improved from -27.9 to -18.6 cmH₂O and the mean AHI decreased from 9.6/h to 6.6/h. With PMA, respiratory disturbance during sleep further improved by changing the body position from the supine to lateral decubitus position.     

Adenosquamous Cell Carcinoma of the Colon with Severe Hypercalcemia: --Report of Two Cases--

Two patients with adenosquamous cell carcinoma of the colon,who presented severe hypercalcemia, are reported. Adenosquamouscell carcinoma of the colon is relatively rare, and there wereonly two cases among 1,053 patients who were hospitalized withmalignancy in the large intestine at the National Cancer CenterHospital during the past 18 years. Both of these cases presentedlethal hypercalcemia in the absence of osseous metastasis, andthere were no other patients who had malignant tumors of thelarge intestine and presented hypercalcemia. These observationssuggest that there is a close relationship between the squamouscell component and the occurrence of hypercalcemia, as is observedin the case of lung cancer. Radioimmunoactive parathyroid hormonewas undetectable in the plasma and the tumor tissue in thesetwo cases.     

Treatment of atelectasis of upper lung lobes. Selective bronchial suctioning with J-shaped catheter tip and guide mark

We developed a technique for blind bronchial suction using a curved-tip catheter with a guide mark, for the treatment of atelectasis of the lower and middle lobes of the lung. Suction of the upper lobe bronchi could not be performed because of the combination of the peculiar anatomy of the upper lobe bronchi with catheter design. We treated successfully two cases of atelectasis of the right upper lobes using a Rusch Metras bronchography catheter with a guide mark which is not readily available. Therefore we devised a J-shape tipped catheter with a guide mark. We have successfully treated 13 episodes of atelectasis of the right upper lobe in 10 patients and one episode in the left upper lobe in one patient with this new catheter.     

Two Cases of Carcinoid Tumor of the Stomach which Responded to Oral Coadministration of Tegafur and Uracil

Tegafur, 1-(2-tetrahydrofuryl)-5-fluorouracil, was administeredin combination with uracil to two patients with carcinoid tumorof the stomach and the effect of the drug was evaluated. The first patient was a 67-yr-old woman. She was admitted becauseof an upper abdominal tumor. Exploratory laparotomy revealeda gastric tumor and an additional huge tumor with liver metastasisand peritoneal dissemination. Histological examination of biopsyspecimens from the gastric tumor and metastatic lesions revealedcarcinoid tumor. Tegafur and uracil were coad-ministered postoperatively.During three months of treatment the gastric tumor improvedendoscopically and the large abdominal tumor decreased from10x10 cm to 4x4 cm. The second patient was a 55-yr-old man. He was admitted becauseof severe diarrhea. Biopsy from a gastric lesion and metastaticskin lesions revealed carcinoid tumor. After coadministrationof tegafur and uracil and mitomycin C, the metastatic skin lesionsbecame smaller and some of the lesions disappeared. The liveralso decreased in size. These two cases suggest the possibility that coadministrationof tegafur and uracil may be effective for carcinoid tumor ofthe stomach.     

Epstein-Barr Virus in Normal Pregnant Women*

ABSTRACT: Acquired immune suppression accompanying normal pregnancy may be associated with reactivation of Epstein-Barr virus (EBV). Pregnant women with reactivated EBV having anti-EA antibodies show high titers of antiviral capsid antigen (VCA) geometric mean titers (GMT) of 522 versus 170 in those lacking anti-early antigen (EA). Among twenty-seven seropositive women at parturition, 17 (63%) had generated antibody to EA, and all 27 (100%) demonstrated significant increases in antibody to VCA (p < 0.01). In contrast, antibody titers to cytomegalovirus, herpes hominis, varicella-zoster, and rubella viruses in the pregnant women were comparable to those found in nonpregnant controls.     

Colo-Rectal Carcinoma in Young Adults

A study of 25 young adults under the age of 29 treated by surgeryfor carcinoma of the large intestine was made to compare with693 older-age group of patients. The incidence of adenocarcinomaof the large intestine in the first thirty years of life was3.5%. At the time of surgery, 64% of the patients had metastaticdisease, and the five-year survival rate for 19 curatively treatedcases was 37%. The coincidental second and third carcinoma ofthe large intestine and the association of familial polyposiscoli were significantly frequent in the younger age group. Onthe other hand, the association of ulcerative colitis or Crohn'sdisease could not be found in either of the group. The highincidence of mucin-producing tumors in the younger group wasalso confirmed. The Cumulative No Evidence of Disease (NED)rate after the curative surgery was lowest among patients ofthe first-three-decade age group and showed; stepwise high valueas the decade of age increased.     

Natural Killer Activity and Antibody-Dependent Cell-Mediated Cytotoxicity in Multiple Myeloma

Natural killer (NK) activity and antibody-dependent cell-mediatedcytotoxicity (ADCC) were studied by routine methods in 11 patientswith untreated malignant monoclonal gammopathy. NK and/or ADCCactivity was clearly reduced in three patients with advanceddisease. Moreover, sera from some myeloma patients impairedthe ADCC and NK activity. A large quantity of purified monoclonalIgG from one patient appeared to inhibit NK and ADCC activityas did high concentrations of pooled polyclonal immunoglobulinfrom healthy persons. In two of these 11 patients, other malignancieswere diagnosed prior to chemotherapy. One of these patients,who had nonsecretory myeloma, had marked impairment of NK andADCC activity; the other, with IgG myeloma, had normal NK andADCC activity.     

ADDITIONAL PROOF OF REDUCTION OF ETHANOL ABSORPTION FROM RAT INTESTINE IN VIVO BY HIGH ACETALDEHYDE CONCENTRATIONS

We investigated intestinal ethanol absorption in rats pretreatedwith saline, cyanamide, 4-methylpyrazole and cyanamide + 4-methylpyrazole.The value of the absorption rate constant in the cyanamide-pretreatedgroup with high acetaldehyde levels was the lowest among thefour groups, but there were no significant differences amongthe remaining groups. We found that high acetaldehyde concentrationitself clearly reduces intestinal ethanol absorption.     

Multivariate autoregressive analysis of carotid artery blood flow waveform in an infant of a diabetic mother with cardiomyopathy

We analyzed the carotid artery blood flow waveform (CABFW) of an infant of a non-insulin dependent diabetic mother with hypertrophic cardiomyopathy (IDM cardiomyopathy) through multivariate autoregressive analysis and compared the developmental change of his CABFW with that of normal newborns. The total power was lower than normal newborns on the second and third day of life when his heart dysfunction was severe, and elevated on the fifth day of life when normal-heart function was recovered. The power of component 3 (C3), of which the damping frequency was 7–11 Hz, was slightly high on the second and third day of life and it decreased to the normal range on the fifth day of life by component analysis. In contrast, the power of C3 increased with decreasing resistance index of anterior cerebral artery (RI of ACA) which shows the cerebral vascular resistance of normal newborns. These results suggest that the carotid artery blood flow volume decreased by low cardiac output and the cerebral vascular resistance decreased to maintain the cerebral circulation, when the heart dysfunction was severe.     

PREVALENCE OF EYELID DERMATITIS IN PRIMARY SJÖGREN'S SYNDROME

Background. The eyelid dermatitis seen in elderly patients is a relatively heterogenous and troublesome disease. Most cases seem to be idiopathic and show resistance to standard dermatologic therapy. Methods. Fifty-two patients with primary definite Sjögren's syndrome (4 men, 48 women, mean age 54 years) were enrolled in this study, and the prevalence of eyelid dermatitis was investigated. Diagnostic criteria for Sjögren's syndrome were based on the criteria proposed by the Japanese Ministry of Health and Welfare. Patch test was performed using ICDRG-European standard allergens and/or eye drops, hair dye, and cosmetics. Results. Of the 52 patients, 22 showed eyelid dermatitis. These changes were much more frequent in elderly patients and showed a good correlation with the presence of ocular dry sensation. No significant difference was observed in clinical and other laboratory findings between patients with or without eyelid dermatitis. Although 8 of the 13 patients showed positive patch test reaction to various allergens, no close relationship existed between the use of a suspected substance and the onset or severity of eyelid dermatitis. Conclusions. These results suggest that the presence of rubbing dermatitis of the eyelid may be one of the cutaneous manifestations of Sjögren's syndrome.