Administration of recombinant human growth hormone normalizes GH-IGF1 axis and improves malnutrition-related disorders in patients with anorexia nervosa

High serum level of GH in the presence of low plasma level of insulin-like growth factor-I (IGF-I) is one of the endocrinological features of anorexia nervosa (AN). Whether the amount of endogenous GH is not enough to increase IGF-I is not certain. We studied the effect of recombinant human growth hormone (rhGH) on the GH-IGF-I axis and on malnutrition-related disorders in this syndrome. Twenty patients with AN were divided into two groups; one (N = 13) was given rhGH (0.33 mg/day), and the other (N = 7) was given placebo for 6 or 12 months, respectively. During each treatment, levels of serum GH, plasma IGF-I, serum thyroid hormones, serum cholesterol, fasting plasma glucose and cardiac function were monitored. Changes in body mass index (BMI) and calorie taken were also evaluated. Plasma IGF-I level increased from 74.4 +/- 41.9 to 269.0 +/- 31.2 microg/L (P<0.001) during administration of rhGH, which associated with a decrease in serum GH level from 17.0 +/- 15.0 to 1.6 +/- 0.8 microg/L (P<0.001). Administration of rhGH increased BMI, body temperature, fasting plasma glucose level, and food intake. Serum level of triiodothyronine, but not thyroxine, increased during treatment with rhGH. The treatment decreased serum levels of both total and HDL-cholesterol. Studies with echocardiography showed an increase in cardiac output during the treatment with rhGH. These improvements were not observed in patients treated with placebo. Administration of rhGH is recommended as one of the methods of managing the patients with AN.     

Adnexal torsion of mature cystic teratoma with hemorrhagic infarction: helpful findings on successive plain abdominal radiographs

Adnexal torsion is a relatively rare cause of lower abdominal pain in women, but in many cases it leads to a serious condition. We present a case of adnexal torsion of a mature cystic teratoma in which hemorrhagic infarction was reflected by progressive enlargement and wall thickening on successive plain abdominal radiographs. There has been no other report describing such changes of adnexal torsion on plain abdominal radiographs.     

Bone fusion algorithm: a new tool to support decision making

Three dimensional angio (3D-Angio) is indispensable in neuroradiology, especially for examinations and interventions of cerebral-aneurysms. 3D-Angio has two modes, 3D-DSA and 3D-DA. The former mode is used to determine vessel structures in detail, and the latter is good at simultaneously determining relationships between vascular and osseous structures. However, it is sometimes difficult to determine these relationships with 3D-Angio if they are close together. The relationship between the skull base and adjacent aneurysm is an essential factor in determining treatment strategy. In order to make this determination, we have developed the Bone Fusion function, which reconstructs vessel and osseous structures separately from rotational DSA data and its mask sequence data, respectively, and two independent 3D data sets are fused in one 3D representation. There are three display modes: fusion, vessel only, and bone only, and those structures are clearly identified by different colors on the fusion images. The Bone Fusion function was applied to hundreds of clinical cases in which 3D-DSA and 3D-DA were used. The Bone Fusion provided important information to determine treatment strategy, although those factors were sometimes lost with 3D-DSA and 3D-DA when the studied vasculatures were adjacent to bone. It was especially useful to apply the Bone Fusion function to aneurysms or tumors adjacent to the skull base.     

Preoperative RFA simulation for liver cancer using a CT virtual ultrasound system

We developed a computed tomography (CT) virtual ultrasound system (CVUS) as an imaging system to support treatment under percutaneous ultrasound (US) guidance. This prototype clinical system, produced in collaboration with Tokyo Medical University, uses display software developed by Toshiba Medical Systems. We examined the utility of this system by scheduling treatment plans preoperatively and simulating puncture and radiofrequency ablation (RFA) for liver cancer. The study enrolled 51 liver cancer patients with 66 nodules 0.8-8cm in diameter in which RFA was performed between June 2004 and December 2004. Virtual US and multiplanar reconstruction (MPR) images were constructed on the basis of DICOM CT data and puncture and ablation of liver cancer were simulated. The following were evaluated: (1) how to avoid complications and determine an appropriate puncture route by simulating puncture with C-mode MPR images; (2) determination of the three-dimensional location of the tumor for ablation, as well as the adjacent organs and vessels, by MPR rotation 360 degrees around the center of the tumor (center lock); and (3) how to determine the center and volume of ablation and avoid injuries to nearby organs and vessels by simulating ablation procedures. C -mode MPR images were effective for (1) determining and modifying the puncture route in 35 of 51 cases (69.6%) and (2) determining the spatial location of vessels and nearby organs in 50 of 51 cases (98.0%) by the center lock; and (3) simulating the ablation helped determine the center and volume of ablation by avoiding injuries to vessels and nearby organs in 45 or 51 cases (88.2%). Taken together, the CVUS allowed easy simulation of local treatment of liver cancer under US guidance using CT data alone and the preoperative simulation predicted an improvement in the safety of local therapy of liver cancer.     

Usefulness of 18F-fluorodeoxyglucose positron emission tomography/computerized tomography in diagnosis and treatment of pelvic recurrence of bladder cancer after radical cystectomy: a case report

A 58-year-old woman visited our hospital with complaints of serious edematous change in the left lower extremity, eleven months after she received total cystectomy and ileal conduit. Although enhanced pelvic computerized tomography (CT) and magnetic resonance imaging (MRI) were repeatedly performed, the pelvic recurrence was not detected. To investigate the presence or absence of pelvic recurrence further, we performed 18F-fluorodeoxyglucose positron emission/computerized tomography (18F-FDG-PET/CT). 18F-FDG-PET/CT clearly demonstrated high uptake by the pelvic lymph node recurrence. We selected radiochemotherapy using a limited irradiation field for the treatment of lymph node recurrence to cure the edema. One month after the treatment, the edema in the left lower extremity was greatly improved. Four months later, 18F-FDG-PET/CT was performed again to evaluate the efficacy of the treatment and reduced uptake of the irradiation field was observed.     

Case of local recurrence of the periurethral proximal-type epithelioid sarcoma successfully treated by repeated regional excision

Proximal-type epithelioid sarcomas are rare soft tissue neoplasms occuring in the soma or thigh and often repeat recurrence and metastasis. We present a case of locally recurrenced proximal-type epithelioid sarcoma that could be treated by regional excision alone. A 62-year-old man visited our institute for a growing mass in the perineal region. Computed tomography (CT) showed a periurethral tumor 22 x 13 mm in diameter in the perineal region. The tumor was excised regionally, and the pathological examination with immunohistochemical staining revealed that the tumor was proximal-type epithelioid sarcoma. Local recurrence of the tumor occurred 2 years 7 months later without any metastatic lesion, and regional excision was performed again. Pathological diagnosis was proximal type epithelioid sarcoma and it was identical to the primary tumor. The patient is free of the disease 1 year after the second surgery of the tumor.     

Anesthesia for extracorporeal shockwave lithotripsy: Teikyo University Hospital experience using the third generation lithotripter

A single-board certified urologist with training and experience in anesthesiology was assigned to treat 502 patients (185 with renal stones, 317 with ureteral stones) using the Dornier Compact Delta lithotripter under general or epidural anesthesia. Data were obtained regarding stone location, stone size, shockwave use, stone-free rate, and complications. In all, 502 stones were treated with the Dornier Compact Delta lithotripter. Among renal stones, 73% were in the renal pelvis. Among ureteral stones, 60% were in the upper, 10% in the middle, and 30% in the lower ureter. Diameters of 61.8% of stones were less than 1 cm. The mean number of shocks was 3,471 at a mean power setting of 5. The stone-free rate for renal stones was 71.5%, while for ureteral stones this reached 99%. The efficiency quotient was calculated as 0.65. One patient with a renal stone developed perinephric hematoma requiring 3 units of transfusion. With a success rate higher than that reported for other lithotripters, the Dornier Compact Delta lithotripter represents a feasible treatment for urolithiasis. We stress that even in the third generation machines the lithotripsy under anesthesia can improve the treatment efficacy.     

Preface and comments : multi-functions of orexin in physiological and pathological conditions--state of the art

Recent advances in searching endogenous peptide ligands for multiple orphan receptors led to the identification of the new peptides, orexin-A and -B in the hypothalamus. Their function was initially considered to be associated with food consumption. However, these peptides have revealed their multiple functions in physiological and pathological conditions, such as sleep-wake control, the hypothalamic-pituitary-adrenal axis, pain modulation and so on. In the present reviews, I focused on the role of orexin on the norepinephrine and acetylcholine arousal system during anesthesia, the autonomic/endocrine regulation and pain pathways. These state-of-the-art reviews might contribute to the discoveries of the new functions of orexins in the anesthetic fields.