Renal cell carcinoma presenting high serum level of CA19-9 due to hydronephrosis: a case report

A 58-year old female was referred to our hospital due to left renal cyst that was pointed out at her health check-up. Abdominal CT scan showed left hydronephrosis with a 20 x 12 x 11cm tumor. The serum CA19-9 level elevated to 4,400 U/ml. Urinary cytology in the left renal pelvis was negative, therefore we could not diagnose whether the mass was renal cell carcinoma or renal pelvic tumor before surgery. She underwent left radical nephrectomy, and frozen section revealed renal cell carcinoma. Immunohistological stain clarified CA19-9 was limited to epithelium lining the renal pelvis and was not contained in carcinoma cells. After the surgery, the serum CA19-9 decreased to the normal range. Serum CA19-9 is known to be sometimes elevated in patients with urothelial carcinoma, but rarely elevated in those with renal cell carcinoma. We thought that hydronephrosis by tumor occlusion caused CA19-9 elevation in our case.     

Serial assessment in eclampsia of cerebrohemodynamics by combined transcranial Doppler and magnetic resonance angiography.

We used two different noninvasive methods, i.e., transcranial Doppler velocimetry and magnetic resonance angiography to serially assess cerebrohemodynamics in a patient with postpartum eclampsia. Five hours after an eclamptic seizure, a decrease in mean velocity in both middle cerebral arteries and slight angiographical spasms indicated cerebral hypoperfusion. On hospital day 8, the patient showed an increase in the mean velocity of the middle cerebral artery, accompanied by significant vasospasms. Abnormal findings were not observed on hospital day 20. These combined methods are useful in assessing cerebrohemodynamics in eclampsia.     

Pure red cell aplasia after major ABO-incompatible bone marrow transplantation: two case reports of treatment with recombinant human erythropoietin

A 34-year-old man with acute myelocytic leukemia (AML: MO) and a 32-year-old woman with AML: M2 developed pure red cell aplasia (PRCA) after receiving a major ABO-incompatible bone marrow transplant (BMT). The first patient responded to recombinant human erythropoietin (rhEPO) therapy, while the second did not. The second patient also received methylprednisolone (m-PSL) but developed reticulocytosis and hemolysis after the administration of m-PSL. Plasmapheresis was then performed and the patient promptly recovered from hemolysis and PRCA. We conclude that close attention must be paid when treating PRCA following major ABO-in-compatible BMT with rhEPO and m-PSL, as there is always the potential for massive hemolysis.     

Kinetic Evaluation of 11C-1-Aminocyclopentane Carboxylic Acid in Rabbits Bearing VX-2 Tumors Using Positron Emission Tomography

Tumor detection with ¹¹C-1-aminocyclopentane carboxylic acid (¹¹-ACPC) showed that this amino acid has a high affinity for malignant tumors. We studied the kinetics of intravenously injected ¹¹C-ACPC in the rabbit VX-2 tumor using positron emission tomography. Three female rabbits bearing VX-2 tumor in the thighs were used. High uptake of ¹¹C-ACPC was seen in the tumor and liver. ¹¹-ACPC in plasma decreased rapidly after injection and its activity in the tumor increased with time. The kinetic evaluation of ACPC uptake into the tumor was performed using the unidirectional transport model. The average values of the transfer constant of ¹¹C-ACPC for VX-2 tumor were 0.030±0.002 ml/min/g. This preliminary result may form the basis for a quantitative analysis of the in vivo distribution of ¹¹C-labeled ACPC in tumors.     

Rescue of Sendai virus from viral ribonucleoprotein-transfected cells by infection with recombinant vaccinia viruses carrying Sendai virus L and P/C genes

The Sendai virus ribonucleoprotein (RNP) showed only very low plaque-forming titers upon transfection and the virus yields after one-step growth were quite limited. We tried to enhance the Sendai virus yield by supplying the viral L and P/C gene products through vaccinia vectors. A combination of the recombinant vaccinia viruses carrying the L gene (Vac-HL) and the P/C gene (Vac-HPC), both of which were driven by the promoter of the vaccinia virus 7.5K protein gene, enhanced the yield only a little whereas another combination of Vac-HLd7.5, the L gene insert of which was driven by the promoter of the vaccinia virus thymidine kinase gene in place of the 7.5K promoter, and Vac-HPC greatly enhanced the Sendai virus yield. This seemed to correlate with the fact that the Vac-HL interfered with Sendai virus growth markedly while the Vac-HLd7.5 did not. These results strongly suggest that the L and P/C gene products act in cooperation as the RNA polymerase, and overproduction of the L protein is inhibitory for Sendai virus growth. This system seems to be of value as a tool for analyzing the functions of L and P/C genes of Sendai virus.     

Ketamine and thiopental sodium: individual and combined neuroprotective effects on cortical cultures exposed to NMDA or nitric oxide

Background. An N-methyl-D-aspartate (NMDA) blocker, ketamine,has been shown to be neuroprotective both in vivo and in vitro.However, ketamine is not commonly recommended for use in patientssuffering from cerebral ischaemia because of its adverse neurologicaleffects. We hypothesized that combined administration of ketamineand thiopental sodium (TPS) would be highly effective in protectingcerebral cortical neurones from ischaemia, with possibly reduceddosages. Methods. We examined the degree of neuroprotection providedby various concentrations of ketamine and TPS, alone and incombination, in cortical cultures exposed to NMDA or a nitricoxide-releasing compound (NOC-5) for 24 h. The survival rate(SR) of E16 Wistar rat cortical neurones was evaluated usingphotomicrographs before and after exposure to these compounds. Results. The SRs of cortical neurones exposed to 30 µMNMDA or NOC-5 were 15.0 (3.8)%, 12.8 (3.1)%, respectively. Higherdoses (5, 10 and 50 µM) but not lower doses (<1 µM)of ketamine improved SRs [57.9 (2.2)%, 61.1 (5.4)%, 76.7 (3.0)%,respectively] against NMDA but not NOC. Enhanced survival wasobserved with combined administration of 5 or 10 µM ketamineand 50 µM TPS [SR 71.3 (4.8)%, 74.7 (3.7)%, respectively,P<0.05 if ketamine alone, P<0.01 if TPS alone], againstNMDA-induced neurotoxicity in vitro. Only the highest dose ofTPS (50 µM) improved survival after NOC exposure. Thisneuroprotection was not influenced by ketamine. Conclusions. These data indicate that a low, clinically relevantdose of ketamine offer significant neuroprotection during prolongedexposure to NMDA but not to NOC. Combinations of reduced dosesof ketamine and TPS exhibited enhanced neuroprotection againstNMDA-induced neurotoxicity. Hence, combinations of these twocommon i.v. anaesthetics agents could be developed to protectthe brain from ischaemia.     

Application of ultrasonography for blunt laryngo-cervical-tracheal injury

BACKGROUND: Bronchoscopy has been the gold standard for diagnosing blunt laryngo-cervical-tracheal injury (BLCTI); however, BLCTI is often undetected. Ultrasonography (US) is an indispensable tool in the field of critical care and traumatology, but has not been considered useful for evaluation of the airway. The aim of this study was to determine the usefulness of US in the diagnosis of BLCTI. METHODS: To determine the detectability of BLCTI by US, we use a model of cylindrical plastic with a protruding mass made of paste. The model was placed in a water bath and US (3.5-MHz probe) was used to try to detect the mass. RESULTS: We could detect the existence of the mass as a high echoic mass with strongly high echoic tail. We used four patients with BLCTIs whose sites of injury were confirmed by computed tomography (CT) and bronchoscopy. We evaluated the larynx and the cervical trachea as their outline of air in the cranial section near the sternal notch using a 3.5-MHz convex probe. The following US findings were compared with CT and bronchoscopic images as specific findings of BLCTI: discontinuity of the laryngo-cervical-tracheal wall and an abnormal mass protruding into the laryngo-cervical-tracheal lumen. Specific findings of BLCTI were detected in three of the four patients, whose sites of injury were the anterior or lateral side of the larynx or the cervical trachea. The site of injury of the remaining patient, where we detected no specific BLCTI findings, was the posterior wall of the larynx. CONCLUSIONS: US is useful for the diagnosis of BLCTI because it is capable of presenting specific images showing BLCTI features such as discontinuity of the laryngo-cervical-tracheal wall and abnormal masses protruding into the lumen; not only as a single diagnostic tool but one tool with many uses.