RECTAL GRANULAR‐CELL TUMOR DIFFICULT TO DISTINGUISH FROM CARCINOID TUMOR

A 60‐year‐old man had a positive fecal occult‐blood test on a medical check‐up. Colonoscopy revealed a yellowish‐white submucosal tumor 8 mm in diameter in the rectum. Endoscopic ultrasonography showed a well‐demarcated mass with a homogeneous, low‐level, internal echo in the second to third layers of the rectal wall. A carcinoid tumor was suspected, and the mass was resected endoscopically. Histopathological examination revealed a granular‐cell tumor. Gastrointestinal granular‐cell tumors rarely arise in the rectum, and the preoperative diagnosis of small lesions is often difficult. In our patient, granular‐cell tumor was difficult to differentially diagnose because the endoscopic and endoscopic ultrasonographic findings closely resembled those of carcinoid tumor. Interestingly, the endoscopic characteristics of the rectal granular‐cell tumor in our patient resembled those of a carcinoid tumor.     

Synergistic antitumor activity of cisplatin and UFT in nude mice bearing transplantable nasopharyngeal hybridoma

Combination therapy with cisplatin (CDDP) and UFT, a drug prepared with 1-(tetrahydro-2-furanyl)-5-fluorouracil and uracil at a mixing molar ratio of 1:4, was examined in nude mice bearing transplantable human nasopharyngeal hybrid cell (A2L/AH). The tumor growth of A2L/AH was inhibited in the group administered UFT 20 mg/kg, but was not in 10 mg/kg group in comparison with the control group. An inhibition rate (IR) of the tumor growth at 20 mg/kg and 10 mg/kg doses was 80.2 and 21.3%, respectively. The group received CDDP (5 mg/kg, q7d x 3, 2 mg/kg, q7d x 3, and 1 mg/kg, qd x 6) by intraperitoneal injection, resulted in 75.2, 37.4, and 23.1% inhibitions, respectively. While, the response rate in the group treated with CDDP (1 mg/kg, qd x 6) and UFT (10 mg/kg) showed a synergistic effects (IR, 66.3%) which was higher than in the group administered CDDP (2 mg/kg, q7d x 3) and UFT (10 mg/kg) (IR, 58.3%).     

The value of intracellular CD41 antigen detection to the diagnosis of acute megakaryoblastic leukemia]

An 11-month-old boy was transferred to our hospital because of fever and bleeding tendency on March 13, 1998. Laboratory studies showed a white blood cell count of 43,360/microliter with 75% blasts, a hemoglobin concentration of 8.4 g/dl, and a platelet count of 23 x 10(3)/microliter. Surface marker analysis with a flow cytometer revealed that only 21% and 11% of the blasts, respectively, were positive for CD41 and CD42b. Treatment with a permeabilizing agent apparently increased the reactivity of the blasts with anti-CD41 monoclonal antibody (MoAb), which can recognize IIb independently of IIIa. However no significant differences were observed in reactivity with anti-CD41 MoAb (which recognizes the IIb/IIIa complex) anti-CD61 MoAb and anti-CD42b MoAb before or after fixation. Blasts positive for platelet peroxidase were observed by electron microscopy, thus confirming the diagnosis of acute megakaryoblastic leukemia. We concluded that the detection of intracellular antigens is useful for the quick diagnosis of acute megakaryoblastic leukemia characterized by low surface expression of megakaryocytic lineage antigens.     

Nerve preservation in tension-free vaginal mesh procedures for pelvic organ prolapse: a cadaveric study using fresh and fixed cadavers

The aims of this study were, using fixed and fresh cadavers, to clarify how closely the pelvic splanchnic nerve, levator ani nerve (LAN), and sacrospinous ligament (SSL) are located and to examine how to avoid nerve injury during the posterior tension-free vaginal mesh procedure (TVMP), in which mesh is applied through the SSL. Macroscopic dissection of fixed cadavers demonstrated that the LAN crossed the inside of the SSL at a point 0–18 mm medial to the ischial spine and entered the muscle at a point 12–26 mm inferior to the ischial spine and 40–55 mm anterolateral to the coccyx. Dissection after TVMP of fresh cadavers revealed that the point of penetration of mesh through the SSL was close to the LAN. To preserve the LAN, penetration of the SSL should be within 5 mm of the lower margin at a point 20–25 mm medial to the ischial spine.     

Clinical evaluation of combination therapy with cefoxitin and amikacin in complicated urinary tract infections

The clinical efficacy of combination therapy using Cefoxitin (CFX) and Amikacin (AMK) was studied in 19 patients with complicated urinary tract infections. Patients received 2 g of CFX i.v. and 100 mg of AMK i.m. twice a day. The overall clinical efficacy of treatment was evaluated by the criteria proposed by the UTI Committee, Japan, as excellent, moderate or poor. The overall clinical efficacy was excellent in 89%, moderate in 5% and poor in 5% of the patients. Of the 21 strains isolated from the patients, 20 strains (95%) were eradicated. No subjective side effects were observed. Drug-related aggravation in laboratory tests were observed slight elevations of glutomic-oxalacefic transaminase, glutamic-pyruvic transaminase and alkaliphosphatase in 2 cases, but all of them were minimal and reversible. Underlying condition-related aggravation was observed a slight elevation of BUN and creatinine clearance in 1 case. These results suggest that the combination therapy with CFX and AMK might be useful in the treatment of complicated urinary tract infections.