Sucrose permeability as a meas of detecting diseases of the upper digestive tract

The healthy gastric epithelium will not allow easy permeation of a disaccharide-sized molecule such as sucrose. However, during gastric damage, intact sucrose can pass the gastric epithelium and ultimately appear in the urine. We examined the relationship between total urinary sucrose excretion and various diseases. We used 149 patients (105 had upper gastrointestinal disease, 12 had gastric cancer and 32 were normal). Subjects were given a solution containing 100g sucrose in 450 c.c. water. All urine was collected for 7.5 h. The urinary sucrose concentration was determined by anion exchange high-performance liquid chromatography. Total urinary sucrose excretion was significantly higher in patients with gastric ulcer and those with gastric cancer than in endoscopically normal controls. In the 34 patients with gastric ulcer, the total sucrose excretion was closely correlated with ulcer size. Ulcer location did not affect urinary sucrose excretion. A strong correlation was also observed between sucrose excretion and lesion size in the 12 patients with gastric cancer. The sucrose permeability test may be a relatively sensitive method to detect gastric disease.     

Retroperitoneoscopic pyeloplasty: Using reconstructive methods based on intraoperative findings

AIM: Reconstructive laparoscopic procedures have been recognized as a less invasive treatment than conventional open procedures. However, although the laparoscopic pyeloplasty has also been accepted as useful, few findings have been reported relevant to the retroperitoneal approach. To elucidate its effectiveness and safety, laparoscopic surgery via the retroperitoneal approach was examined in our institution. Furthermore, the importance of laparoscopic observation for ureteropelvic junction and urine passage ureteropelvic junction without indwelling ureteral stent. METHODS: Between July 1998 and December 2004, 13 men and 15 women underwent laparoscopic retroperitoneal surgery for ureteropelvic junction obstruction. The mean patient age was 33.6 years (range: 13-70 years). Methods of repair were determined by intraoperative findings for the relationship between the ureteropelvic junction and surrounding vessels. An indwelling ureteral stent was removed before initiating laparoscopic operation to observe the relationship between ureteropelvic junction and aberrant vessels more precisely. RESULTS: An aberrant renal vessel was found in 13 patients (46%). Dismembered pyeloplasty was carried out in 21 patients, Y-V plasty in five patients and Hellstrom technique in two patients. Ureteral transposition was not required in dismembered pyeloplasty cases. All patients achieved retroperitoneoscopic pyeloplasty without open conversion. The mean operative time was 272 min (range: 155-490 min). The mean estimated blood loss was 44 mL (range: 10-200 mL). No major complications were observed during the intraoperative period, but urinary tract infection occurred in two patients in the postoperative period. In all patients except one, obstruction was improved or resolved. CONCLUSIONS: Laparoscopic retroperitoneal surgery is not only able to repair ureteropelvic junction obstruction, but can also be done safety and less invasively. We believe that laparoscopic observation without indwelling stent will contribute to a more appropriate choice of pyeloplasty.     

Characteristics of Cefdinir Uptake by Rabbit Small Intestinal Brush-border Membrane Vesicles

Aminocephalosporins with peptide-like structures have been shown to be absorbed by the intestinal peptide carrier. We investigated the transport mechanism of cefdinir, an oral monocarboxylic acid cephalosporin, using rabbit small intestinal brush-border membrane vesicles. Transport of cefdinir showed a slow and almost linear uptake rate for concentrations up to 30 mm with and without an inward H+ gradient. No overshoot phenomenon was observed in the presence of an inward H+ gradient. The uptake rate increased only slightly with decreasing extravesicular pH, and a protonophore had little effect on the uptake. Aminocephalosporins such as cephalexin only slightly inhibited cefdinir uptake even in the presence of an inward H+ gradient, and vice-versa. Monocarboxylic acids such as acetic acid and salicylic acid had little effect on cefdinir uptake. These findings suggest that in contrast with other oral cephalosporins cefdinir uptake through the brush-border membrane is slow and involves a mechanism similar to passive diffusion.     

C1 inhibitor deficiency simulating systemic lupus erythematosus

A 48–year-old Japanese woman with systemic lupus erythematosus-like lesions of the skin and lips was found to have hereditary angio-oedema. Complement studies revealed low CH5O, C19, C4 and C1 inhibitor levels, with normal C3 and C5 levels. Dramatic clinical improvement followed fresh normal human blood transfusion and systemic betamethasone administration, while the deficient complement component levels were unchanged.     

The effect of coping on the caregiver of elderly patients with dementia

Abstract Ninety-eight caregivers of elderly patients with cognitive impairment were surveyed by questionnaires in order to examine the relationship between their coping strategies and subjective burden. Confrontative coping and avoidance coping were significantly associated with their burden. The severity of cognitive impairment and the behavioral problems of the patients were also significantly associated with the caregivers' burden. However, a multiple regression analysis suggested that the caregivers' coping strategies may be more important than the patients' condition in terms of the effects on the burden.     

FOLLOW-UP STUDIES ON THE SLEEP EEG AFTER PREFRONTAL LOBOTOMY –Polygraphic Investigations during Spontaneous Nocturnal Sleep–

By taking polygraphic recordings of EEG throughout spontaneous nocturnal sleep of the chronic schizophrenics with prefrontal lobotomy, the patterns of their EEG and sleep course were briefly described. It was found that the two cases who have had only lobotomy as the special psychiatric treatment showed somewhat less frequent REM stages as compared with the controls. In contrast, in other cases who have received special psychiatric treatments inclusive of frequent ECTs, insulin and fever therapy, it is worthy of note that there were observed somewhat different characteristics in the sleep course and in the appearance of the REM stage as compared to those of the two foregoing cases. As for the pattern of EEG, all the five cases revealed some unusual sleep patterns, showing slow waves of slightly low voltage in the deep stage, and spindle waves of alpha band overlapped on delta waves, appearing from the beginning of sleep course. There was seen irregular derangement in the relationship between the degree of depth of sleep and pulses as generally observable in the autonomic nervous function, and also a similar disorder in the relationship of the REM stage to pulses. That is to say, there was often observed a phase which cannot be construed as an inseparable factor between the REM stage and pulses. In this paper, we have discussed about the follow-up studies of the lobotomized schizophrenic patients by polygraphic investigations, and assumed that there might persist some latent organic changes of the brain, especially in the cases who underwent lobotomy plus frequent ECTs, etc. treatments.     

A Preliminary Report on Autologous Bone Marrow Transplantation for the Treatment of Advanced Non-Hodgkin's Lymphoma

Four patients with advanced non-Hodgkin's lymphoma of unfavorablehistology were treated with marrow-lethal doses of cyclophosphamide(CY) and total body irradiation (TB1) followed by the infusionof cryopreserved autologous marrow. All four patients showedengraftment after autologous bone marrow transplantation andachieved complete remission (CR). Three of them, however, developedrelapse in 1.7, 12.9 and 14.5 mo respectively after the transplantation.The other patient has survived in drug-free CR for more than16.6 mo. There was no treatment-related death although therewere some tolerable complications. These data suggest that theCY-TBI regimen may be effective in inducing CR in patients withadvanced non-Hodgkin's disease but it does not contribute topreventing relapse.