Influence of the anti-T4 autoantibody cross-reacting with T3 on serum T3 level determined by RIA

We encountered a patient who showed remarkably high binding capacities of both 125I-T4 and 125I-T3, which suggests the presence of antithyroid hormone autoantibody. However, the serum level of T3 in the patient was not abnormal. Study of the specificity of anti-thyroid autoantibody revealed that the antibody present in the patient was the anti T4 antibody, which cross-reacted with T3. In addition, the binding capacity of the T4 autoantibody with T3 was inhibited by T4. Endogenous T4 is always present when T3 is determined by radioimmunoassay. Our findings indicate that the normal T3 level in the patient was because endogenous T4 inhibited the autoantibody binding with T3.     

MAOA/B deletion syndrome in male siblings with severe developmental delay and sudden loss of muscle tonus

Deletion of the monoamine oxidase (MAO)-A and MAO-B was detected in two male siblings and in their mother. The approximately 800-kb deletion, extending from about 43.0 MB to 43.8 MB, was detected by array comparative genomic hybridization analysis. The MAOA and MAOB genes were included in the deletion, but the adjacent Norrie disease gene, NDP, was not deleted. The boys had short stature, hypotonia, severe developmental delays, episodes of sudden loss of muscle tone, exiting behavior, lip-smacking and autistic features. The serotonin levels in their cerebrospinal fluid were extremely elevated. Another set of siblings with this deletion was reported previously. We propose recognition of MAOA/B deletion syndrome as a distinct disorder.     

Effects of granulocyte colony-stimulating factor and granulocyte-macrophage colony-stimulating factor on respiratory burst activity of neutrophils in patients with myelodysplastic syndromes.

The superoxide (O2-)-releasing capacity in response to N-formyl-methionyl-leucyl-phenylalanine (FMLP) and the priming effects of recombinant human granulocyte colony-stimulating factor (rhG-CSF) and granulocyte-macrophage colony-stimulating factor (rhGM-CSF) on FMLP-induced O2- release were investigated in neutrophils from 14 patients with myelodysplastic syndromes (MDS). The O2(-)-releasing capacity in MDS neutrophils varied from patient to patient. As compared with normal neutrophils, the O2(-)-releasing capacity in MDS neutrophils was increased in 9/14 patients, normal in three patients and decreased in two patients. There was no close relationship between the O2(-)-releasing capacity and the peripheral blood neutrophil count or the plasma concentration of C-reactive protein. The priming of neutrophils by rhG-CSF was not observed in five patients, whereas rhGM-CSF primed neutrophils from all patients. The priming effect of rhGM-CSF was consistently greater than that of rhG-CSF in each patient. The intravenous administration of rhG-CSF (300 micrograms/body) to two MDS patients showed an increase in the peripheral blood neutrophil count and enhancement of neutrophil O2- release. These findings demonstrate that the neutrophil O2(-)-releasing capacity in MDS varies from patient to patient and is not always impaired, and that rhGM-CSF is able to prime neutrophils which never respond to rhG-CSF.     

Oral health status among low‐income people admitted to Osaka Socio‐Medical Center in Japan

Objective : To examine the dental condition, perceived oral symptoms, and frequency of dental visits among low‐income people admitted to Osaka Socio‐Medical Center (OMSC) and to compare with Japanese national survey respondents. Methods : Oral health examinations for inpatients admitted to OMSC were performed from August to November 2004. In total, 113 inpatients who were in the recovery period without acute symptoms, were selected. Results : 109 inpatients received dental examination. All participants were male. About half of the subjects (49%) did not have any medical insurance, and the percentage of subjects who had 20 or more teeth was smaller than in a national survey in all age groups. The subjects had a higher reported frequency of oral symptoms compared with respondents to the national survey. Accessibility to dental clinics among subjects was notably low. Conclusion : Dental condition and perceived oral symptoms among the subjects were poor compared to national survey respondents. Dental care to improve the oral health condition of this segment of the population is needed.     

Endoscopic appearance of the colon and small intestine of a patient with hemorrhagic enteric graft-vs.-host disease

Endoscopic appearance of the gastrointestinal tract of a patient with severe hemorrhagic enteric graft-vs.-host disease (GVHD) is presented. A 29-year-old man with chronic myelogenous leukemia suffered from severe enteric GVHD after allogeneic bone marrow transplantation. Endoscopy showed hemorrhagic ulceration of the upper jejunum, terminal ileum, and colon at the onset of melena. Sections of biopsies were compatible with acute GVHD. Repeat endoscopy showed gradual healing of the lesions after steroid pulse and antilymphocyte globulin therapy, but the patient died of cytomegalovirus pneumonitis 14 months later. Autopsy revealed submucosal fibrosis of the small intestine and colon.     

First-trimester serum folate levels and subsequent risk of abortion and preterm birth among Japanese women with singleton pregnancies

Objectives

To determine whether a low serum folate level during the first trimester predicts subsequent late abortion, preterm birth, or fetal growth restriction (FGR).

Study design

A prospective cohort study involving 5,075 women whose serum folate levels were measured during the first trimester. The participants were informed of their serum folate levels.

Results

The pregnancy duration, birthweight, rate of late abortion/preterm birth, and the rate of FGR did not differ significantly among the four groups classified according to folate status. The mean serum folate levels did not differ among quartiles classified according to the gestational week at the time of delivery. Nineteen of the 20 women with folate deficiency gave birth at term to infants with a birthweight of 3.132 ± 321 g; only one infant had FGR.

Conclusion

Low serum folate levels during the first trimester were not associated with the risk of late abortion, preterm birth, or FGR.     

Survey of Japanese infertile couples' attitudes toward surrogacy

Aim. To clarify Japanese infertile couples' attitudes toward surrogacy, and analyse the results according to the contextual factors: ethical, social and medical aspects.

Methods. We performed a questionnaire survey anonymously on the attitude toward gestational surrogacy and traditional surrogacy in Japanese infertile couples (103 women and 60 men) between June and August 2000. We examined the relation between the acceptability of surrogacy and the background factors (age, type of procedure, the number of clinics visited, etc.), and also analysed the woman required as each type of surrogate mother whether the presence or absence of siblings in any of the infertile couple.

Results. The rates of using gestational and traditional surrogacy if they were necessary were 17% and 7% of women, 23% and 8% of men, respectively. ART group, ≥35 years of age group and ≤2 clinics visited group as a contextual factor influenced their affirmative determinants. Approximately 70% of the infertile couples preferred anonymity as a surrogate gestational mother. Regardless of whether each partner had a full sister, these tendencies were observed.

Conclusions. We found the contextual factors related to the acceptability of surrogacy. The ongoing deliberations toward surrogacy considering certain conditions of a concerned couple would be highly desirable.     

Status of treatment for the overall population of patients with stage IVb endometrial cancer,and evaluation of the role of preoperative chemotherapy: A retrospective multi-institutional study of 426 patients in Japan

Objective

We previously reported on the role of cytoreduction in 248 patients with surgical stage IVb endometrial cancer (EMCA). This study aimed to evaluate the clinical characteristics, prognosis according to initial treatment, and impact of preoperative chemotherapy in the overall population of patients with clinical and surgical stage IVb EMCA.

Methods

A multi-institutional retrospective analysis was performed in 426 patients diagnosed with clinical and surgical stage IVb EMCA from 1996 to 2005. Factors associated with overall survival (OS) were identified using univariate and multivariate analyses.

Results

The median OS for all 426 patients was 14 months. Patients were divided into three groups according to their initial treatment: primary surgery group (n = 279), primary chemotherapy group (n = 125), and palliative care group (n = 22). The median OS times for these groups were 21, 12, and 1 month, respectively (p < 0.0001). Patients in the primary surgery group had better performance status (PS) and lower numbers of extra-abdominal metastases than those in the primary chemotherapy group. Multivariate analysis identified good PS, endometrioid histology, absence of clinical intra-abdominal stage IVb metastasis, hysterectomy, and chemotherapy as independent predictors of OS. In the primary chemotherapy group, 59 patients subsequently underwent surgery, and these patients had similar OS to those in the primary surgery group.

Conclusions

Hysterectomy and chemotherapy may prolong OS in selected patients with stage IVb EMCA. Our data suggest that primary chemotherapy followed by surgery may be a useful treatment choice in patients not suitable for primary surgery.     

Adequacy of control of preoperative hypertension can affect landiolol-induced hemodynamic changes in elderly patients during emergence from anesthesia

We examined the dose-related effects of landiolol on hemodynamics during emergence from anesthesia of elderly patients with uncontrolled hypertension. Thirty-three normotensive, 34 controlled hypertensive, and 31 uncontrolled hypertensive elderly patients were divided into three groups: control (saline infusion), 0.125 landiolol group, and 0.25 landiolol group. Landiolol or saline infusion was administered at 0.125 (0.125 landiolol group) or 0.25 (0.25 landiolol group) mg/kg/min for 1 min and thereafter decreased to 0.04 or 0.08 mg/kg/min, respectively, until extubation, under regular heart rate and blood pressure monitoring. In normotensive patients, the 0.125 mg/kg/min landiolol infusion was suitable for stabilization of systolic blood pressure and heart rate during tracheal extubation. Controlled hypertensive patients required a 0.25 mg/kg/min landiolol infusion for stabilization of systolic blood pressure and heart rate during tracheal extubation. In uncontrolled hypertensive patients the 0.25 mg/kg/min landiolol infusion could stabilize heart rate, but not systolic blood pressure. In conclusion, the adequacy of preoperative hypertensive control could affect landiolol infusion-induced hemodynamic stability during emergence of elderly patients from anesthesia.