Mediastinal ganglioneuroma with the secretive activity of catecholamines, visualized by 131-I-MIBG scintigraphy

A 6-year-old girl with mediastinal ganglioneuroma was reported. Preoperative examinations revealed that the tumor had both secretive activity of catecholamine and uptake of 131-I-MIBG. Clinical symptom was only supraventricular premature beat on ECG. The tumor, which was located at the left upper mediastinum, was well encapsulated. Total surgical removal was accomplished. Subsequently serum and urine levels of catecholamine were normalized. Detailed histological examination of the tumor revealed benign ganglioneuroma. No blastic change was recognized. We postulate that secretive activity of catecholamine and uptake of 131-I-MIBG cannot suggest malignancy necessarily.     

Bladder carcinoma with Werner syndrome

Werner syndrome is a rapid premature aging disease and is considered chromosomal instability syndrome, occasionally associated with malignancy. Urologic malignancy associated with this syndrome is unusual. Herein we report a case of Werner syndrome with urinary bladder carcinoma.     

Stimulatory effects of insulin and insulin-like growth factor I on migration and tube formation by vascular endothelial cells.

The effects of insulin and insulin-like growth factor I (IGF-I) on migration, proliferation and tube-forming activity of endothelial cells were investigated, by using bovine carotid artery endothelial cells. Migration was assayed by a filter membrane technique and tube formation was assayed by a quantitative angiogenesis in vitro model which we have recently developed. In this model, endothelial cells are cultured between two layers of type I collagen gel and become organized into tube-like structures which mimic capillaries in vivo ultrastructurally. Insulin (50-1000 microunits/ml) and IGF-I (10-200 ng/ml) significantly stimulated migration of endothelial cells in a dose-dependent manner with a maximal stimulation of 3.0-fold at 1000 microunits/ml for insulin and 3.8-fold at 200 ng/ml for IGF-I (P less than 0.01). Insulin at concentrations up to 1000 microunits/ml and IGF-I up to 100 ng/ml did not affect proliferation of endothelial cells. When insulin or IGF-I was added in culture medium on collagen gels, tube-forming activity of endothelial cells was markedly stimulated. The specific lengths of tubes significantly increased with the increase in insulin concentration from 25 to 100 microunits/ml (P less than 0.01). At 100 microunits/ml, the stimulation was 1.77-fold (P less than 0.01). IGF-I (1-100 ng/ml) also stimulated the elongation of tubes dose-dependently with a maximal stimulation of 1.96-fold at 100 ng/ml (P less than 0.01). Thus, insulin and IGF-I at pathophysiological concentrations stimulate migration and tube-forming activity of endothelial cells, suggesting that these polypeptides may stimulate repair of endothelial injury in cases such as atherosclerosis and may act as a stimulator of angiogenesis.     

A case of malignant localized visceral pleural mesothelioma]

We experienced malignant localized mesothelioma of which origin was visceral pleura. According to, 1) the preoperative chest X-ray and chest CT which showed extra-pleural sign, 2) the rapid tumor growth, and 3) the result from needle biopsy, we diagnosed malignant localized mesothelioma of which origin was parietal pleura. Surgical treatment was performed, and diagnosed that its origin was visceral pleura. The tumor invaded the lung. It is dangerous to diagnose by means of needle biopsy because of malignant cell implantation. We recommend that firstly the surgical treatment should be carried out for malignant mesothelioma, which needs extended resection for preventing its recurrence.     

Spontaneous peripelvic extravasation associated with primary ureteral tumor: a case report]

A case of spontaneous peripelvic extravasation associated with primary ureteral tumor is reported. A 56-year-old woman presented with left flank pain. Excretory urogram and abdominal computed tomographic (CT) scan demonstrated left hydronephrosis with extravasation of contrast materials around the renal pelvis. Retrograde pyelogram showed the filling defect in the left upper ureter. Under diagnosis of ureteral tumor, total nephroureterectomy was performed. Histological findings revealed transitional cell carcinoma. 80 cases of spontaneous peripelvic extravasation in Japan were reviewed and discussed briefly.     

Posttraumatic stress disorder in victims of sexual assault--related to depression or physical symptoms]

To clarify the clinical characteristics of mental disorders in sexual assault victims, we investigated the victims focusing on PTSD, depression, physical symptoms, and their relationships. SUBJECTS: Participants were 46 treatment-seeking female victims of sexual assault who consulted four hospitals, one clinic and one psychological services center, between February 2000 and April 2001. The mean +/- SD age of the participants was 28.0 +/- 8.9 years, the mean +/- SD period from the traumatic event was 94.5 +/- 88.0 months. PTSD was diagnosed and evaluated using a structured interview (Clinician-Administered PTSD Scale for DSM-IV: CAPS). Depressive symptoms were assessed using Self-rating Depression Scales (SDS). Physical symptoms were assessed using the Physical symptom scale developed by the authors. RESULTS: Thirty-two participants (69.6%) met the criteria for PTSD in their current diagnosis, and 41 (89.1%) had the disorder at some point during their lives. SDS score and Physical symptom scale score of the PTSD group were significantly higher than those scores of the non-PTSD group. The SDS score correlated with the Avoidant-numbing score. The Physical symptoms scale score correlated with the Intrusion score and Hyperarousal score. We think that the PTSD group had the co-existing depression secondary to PTSD. Although previous studies have discussed the relationship between physical symptoms and Hyperarousal symptoms, this study suggested that physical symptoms were related to Intrusion symptoms as much as Hyperarousal symptoms. We found 2 patterns when PTSD patients reported physical symptoms related to Intrusion symptoms. The patterns were caused (1) by physiological reactivity on exposure to internal or external cues that symbolize an aspect of the traumatic event, and caused (2) by somatic reenactment symptoms. CONCLUSION: We discuss the importance for clinicians to distinguish Intrusion symptoms from physical symptoms as well as Avoidant-numbing symptoms from depressive symptoms on PTSD diagnosis. Because sexual assault victims have difficulty in talking about the traumatic experience, clinicians should pay attention to these findings in developing therapeutic plans for the victims.     

Radiotherapy in the management of Graves' ophthalmopathy

BACKGROUND: To report the results of radiotherapy for patients with failure, adverse reactions or relative contraindications to the use of steroids or immunosuppressants, by using newly developed quantitative indexes. METHODS: Fourteen female and six male patients with Graves' ophthalmopathy were treated with radiotherapy between 1989 and 1996. Prior to radiotherapy, eight patients received treatment with prednisone, four received immunosuppressants and four received a combination of both. Four patients with contraindications to steroids were initially managed with radiotherapy. Most of the patients received a dose of 24-28 Gy in 2 Gy fractions. We used the newly developed motility limitation index to assess extraocular motility. RESULTS: Treatment was well tolerated. There have been no late complications. All 12 patients with soft tissue signs such as edema, irritation, tearing and pain were improved. Proptosis did not improve or improved only slightly, 3 mm at best. However, proptosis in all but two has been stabilized and has not deteriorated in the follow-up period. Most of the patients have experienced an improvement of eye-muscle motility. Extraocular muscles that work for elevation were impaired more severely than the other muscles and this tended to remain. Of the 16 patients using steroids before or when radiotherapy was initiated, 15 were tapered off and only one patient required additional steroids, thus sparing the majority from steroid adverse reactions. CONCLUSION: Radiotherapy was effective in preventing exacerbations of active inflammatory ophthalmopathy in patients with Graves' disease with minimal morbidity and thus eliminated the adverse reactions associated with protracted corticosteroid use. The newly developed motility limitation index was useful in detecting delicate changes in motility of individual extraocular muscles.      

A life span study of exploratory eye movements in healthy subjects: gender differences and affective influences

To evaluate age and gender differences as well as effects of affection, we examined exploratory eye movements. Exploratory eye movements were recorded in healthy subjects (57 women and 57 men) ranging from 9 to 74 years. All subjects were divided into three groups as pre puberty, young, and older adults to study the influences of age and gonadal hormones. Exploratory eye movements were analyzed for total eye scanning length (TESL), and total numbers of gaze points (TNGP) as subjects viewed neutral or affectively charged pictures. TESL and TNGP in older adults were significantly larger than that in both pre puberty and young adults for crying babies. TESL and TNGP in pre puberty were significantly smaller than that in both young and older adults for circles. TESL and TNGP in pre puberty were significantly smaller than that in older adults for smiling babies. Pre puberty and young adult of both genders for crying babies showed significantly shorter TESL than for when smiling babies. When viewing circles, young adult women had shorter TESL than men. TNGP in young adult women was smaller than in men for circles or crying babies. TNGP of young adult women in the visual right field was significantly smaller than in men. TNGP for crying babies was significantly smaller than that for smiling babies in young adults of both genders for the left field. Exploratory eye movements thus are a useful marker of visual cognitive function. Gender differences were limited to younger adults, suggesting influences of gonadal hormones.