Reversal of altered intestinal mucosal immunity in rats fed elemental diet by supplementation of oleic acid

We have previously demonstrated that elemental diet (ED) induces decreased lymphocyte transport in intestinal lymph and significant changes in T cell subsets and the number of IgA-containing cells in gut-associated lymphoid tissues of rats. In order to examine whether the low fat content contributes to the induction of immunological changes in gut-associated lymphoid tissues, the effects of additional fatty acid in the ED were investigated. Rats were divided into four groups: elemental diet alone, elemental diet supplemented with 5% oleic acid (OA), elemental diet with 10% OA and conventional diet as a control. These diets were given at the same daily calorie intake for 4 weeks. The flow rate of intestinal lymph showed no significant difference between the four groups. However, lymphocyte flux as well as the percentage of CD3⁺ and CD4⁺ cells were significantly greater in the control and the 10% OA groups than in the ED and 5% OA groups. Intestinal lymph showed decreased concentrations of IgG and IgA in the ED group, whereas the addition of 10% OA significantly attenuated the decrease in these levels. In mesenteric lymph nodes, the CD4⁺/CD8⁺ ratio was significantly decreased in the ED group, but 10% OA reversed this change. Immunohistochemical analysis of the ileal mucosa showed that in the ED group the population of CD4⁺ cells was decreased, while the number of CD8⁺ cells was increased. Supplementation of OA to ED produced similar stepwise attenuation of the changes in lymphocyte subpopulations in the lamina propria, while the 10% OA group reached levels that were not statistically different from controls. In the elemental diet, group, there was a significant decrease in immunoglobulin-containing cells of the IgA class in the lamina propria of the intestine. Similarly, the addition of OA induced dose-dependent recovery in the number of IgA-containing cells. These results suggest that a low dietary concentration of fat may be closely related to changes in lymphocyte transport in intestinal lymph and mucosal immunity of intestinal mucosa induced by the feeding of a long-term ED.     

Transoral vs. Endoscopic Endonasal Approach for Clival/Upper Cervical Chordoma

The surgical results of 18 cases of clival/upper cervical chordoma treated in the last decade via the endoscopic endonasal approach (EEA, 9 cases) and the transoral-transpalatal approach (TO-TPA, 9 cases) were compared. Each group showed the same incidence of subdural invasion, with 5 cases each. The superior (frontal base) and lateral surgical fields were wider by EEA, but the inferior view lower than the cranio-vertebral junction (CVJ) was wider by TO-TPA. Gross total removal was achieved in 3 cases in the EEA group, but in only 1 case in the TO-TPA group. Differences in radicality might be due to the extent of the lateral and subdural overview. However for large tumors extending below the CVJ, TO-TPA was the only viable approach for surgical removal. Surgical complications were higher in the EEA (4 cases) than the TO-TPA group (1 case), and were mainly caused by aggressive management of subdural invasion in the EEA group. Post-operative oral intake was earlier and the operative time was shorter in the EEA group. The surgical results were more radical and less invasive in the EEA group than the TO-TPA group. However in tumors extending below the CVJ, the surgical field in EEA was limited, indicating the need to use the transoral route or a combination of routes. A higher complication rate following subdural management was a negative factor that requires improvement in the EEA group and two-staged EEA followed by a transcranial approach may be considered for the cases with subdural invasion.     

Peritoneal carcinomatosis in refractory seminoma

Intraperitoneal metastasis from a testicular germ cell tumor is very rare. We report a case in a 33-year-old man who was referred to Hokkaido University Hospital, Hokkaido, Japan, for further therapy for refractory seminoma. Physical examination revealed abdominal distension as a result of ascites, and cytology of the ascites showed seminoma cells. Although the ascites completely disappeared after treatment with a novel regimen of irinotecan-based chemotherapy, the patient had a recurrence of ascites and died of progressive disease 5 months after the start of the therapy.     

Recovery of health related quality of life after radical prostatectomy in Japanese men: A longitudinal study

BACKGROUND: We performed a longitudinal survey of health related quality of life (HRQOL) after radical retropubic prostatectomy (RP) in Japanese men with localized prostate cancer. METHODS: The present study started with self-reported HRQOL assessments provided by 72 patients who received only RP. The RAND 36-Item Health Survey and the University of California, Los Angeles Prostate Cancer Index were administered before and 3, 6 and 12 months after RP. RESULTS: Patients who underwent RP showed problems in some domains of general HRQOL, but these problems diminished over time. Urinary function declined substantially at 3 months and continued to recover at 6 and 12 months, but scored lower than the baseline. Urinary bother at 3 months had a significant decrease, but at six months it turned out to be the same as the baseline. The data of sexual function and bother showed a substantially lower score after RP. The sexual bother score of the younger men was significantly worse than that of the older men. Those who underwent nerve sparing procedures experienced significantly better recovery of urinary and sexual functions than the non-nerve sparing group. CONCLUSION: Despite reports of problems with sexuality and urinary continence, general HRQOL was mostly unaffected by RP after 6 months. Although there was a substantial decrease in urinary function, recovery from urinary bother was rapid. Deterioration of the sexual domain was remarkable throughout the postoperative period. Therefore, careful attention should be given to preoperative counseling, especially for younger patients.     

Selectivity of serum immunoreactive prolyl 4-hydroxylase as a marker for hepatic necrosis

To investigate the selectivity of serum immunoreactive prolyl 4-hydroxylase (S-IRPH) as a marker for hepatic necrosis, sera were taken from patients with hepatic inflammation and hepatic necrosis. The concentration of immunoreactive prolyl 4-hydroxylase in the sera was determined by radio-immunoassay, and S-IRPH and alanine aminotransferase (ALT) data were plotted. Patients with hepatic necrosis showed mainly prolyl 4-hydroxylase elevation while patients with inflammation had both prolyl 4-hydroxylase and alanine aminotransferase elevations. The addition of serum immunoreactive prolyl 4-hydroxylase to current serum markers would be useful in investigating the pathophysiology of hepatocellular damage, particularly in differentiating between hepatic necrosis and inflammation.     

Nicorandil, a Potassium Channel Opener, Abolished Torsades de Pointes in a Patient with Complete Atrioventricular Block

TdP is a serious complication of AV block. We report a case of complete AV block with QT prolongation who had bouts of TdP resistant to lidocaine and isoproterenol. Temporary pacing could not be performed, because insertion of a pacing lead triggered TdP that deteriorated into ventricular fibrillation. Nicorandil, a potassium channel opener, shortened the QT interval and abolished TdP. This may suggest that potassium channel opening drugs are clinically effective against TdP associated with bradycardia-dependent QT prolongation.     

Morphological study by an 'in vivo cryotechnique' of the shape of erythrocytes circulating in large blood vessels

Changes in the shape of erythrocytes circulating in large blood vessels of mice were examined by our 'in vivo cryotechnique'. The abdominal aorta and inferior vena cava (IVC) were cut vertically with a precooled knife and simultaneously an isopentane–propane mixture (−193°C) was poured over them for freezing. They were freeze-substituted in acetone containing 2% osmium tetroxide. Some specimens were embedded in Quetol-812, and thick or ultrathin sections were examined by light or transmission electron microscopy. Serial ultrathin sections were used to reconstruct 3-dimensional images of native erythrocytes. Others were transferred into t-butyl alcohol and freeze-dried for scanning electron microscopy. The tissue surfaces were sufficiently frozen to prevent large ice crystal formation, and erythrocyte shapes were also preserved. The shapes of circulating erythrocytes appeared to be varied in the abdominal aorta but typical biconcave discoid shapes were rarely observed. Conversely, erythrocytes were approximately biconcave discoid in shape in the IVC. Our in vivo cryotechnique was useful for clarifying the in vivo morphology of erythrocytes circulating in large blood vessels.     

Life of Advanced Cancer Patients after Knowing the Nature of Their own Disease: A Personal Experience of Seven Cases

To seven patients suffering from advanced cancer who wishedto know what their disease was and whose families supportedthem in their wish, I informed them of the name of the diseaseand how advanced their case was. After being told they had cancer,not only did the patients become more cheerful to and more trustfulof their families, but also they came to place greater confidencein us doctors and nurses. Their wish to live was strong andthey all wanted to have their anticancer therapy continued.At the terminal stage, four of them merely wanted to have theirpain relieved, and two of them became depressive when the symptomsof approaching death became evident. But judging from the totalclinical course of the seven carefully screened patients, Ibelieve that informing them of the true nature of the diseasebrought about favorable results.     

CYCLIC PEPTIDES

Several cyclo (-l -aminoacyl-ΔAla-) (aminoacyl = Ala, Val, Leu, Phe, Pro and Lys (?-Ac)) were prepared by tosylation and successive detosylation of cyclo (-l -aminoacyl-l -Ser-), which were synthesized via the Nitecki and Fischer methods. Hydrogenation of the double bond of dehydroalanine residues in cyclodipeptides was carried out using Pd black in methanol at 1-atm pressure and room temperature. The degree of asymmetric hydrogenation was assessed by determining the amounts of l- and d -alanine by a modified Manning and Moore procedure. When l -valine was used as a chiral source, l -alanine residue with chiral induction of 98.4% was derived from cyclo (-l -Val-ΔAla-). l -Amino acids other than l -proline also were effective in inducing remarkable asymmetric hydrogenation. Hydrogenation of α, β-dehydro-α-aminobutanoic acid residues in cyclodipeptides produced l -α-aminobutanoic acid residues with effective chiral induction to the same extent as observed with dehydroalanine residues. Optically pure l -alanine was prepared from cyclo (-l -Lys(?-Ac)-ΔAla-) via asymmetric hydrogenation. A mechanism of chiral induction is discussed.     

Metastatic Hepatocellular Carcinoma Mimicking an Early Gastric Cancer: A Case Report

A case of hepatocellular carcinoma metastasizing to the stomachin a 71-year-old man is reported. The gastric metastasis showeda flat elevation compatible with type IIa of early gastric canceron roentgenograms and a white saucer-like, discolored elevationon endoscopic pictures. It had none of the modalities of polypoidsubmucosal tumor usually observed in metastatic tumors of thestomach. Biopsy specimens of the lesion were not sufficientto distinguish metastatic or primary gastric cancer. The patientdied of massive bleeding from varices at the gastric cardia.Autopsy disclosed hepatocellular carcinoma diffusely extendingto the bilateral lobe of the cirrhotic liver. Sections of thegastric mass showed bile deposits in the malignant cells andthe same cell pattern as the hepatic primary tumor. These findingsconfirmed it as the metastatic involvement of the stomach byhepatocellular carcinoma. Although gastric metastases usually form polypoid submucosaltumors with or without central ulceration, it is quite unusualfor gastric involvements of hepatocellular carcinoma to formsuch a modality.