Intradural extramedullary hemangioblastoma differentiated by MR images in the cervical spine: a case report and review of the literature

We report a rare case of hemangioblastoma existing in the intradural extramedullary location diagnosed by magnetic resonance imaging (MRI) examination alone. A 46-year-old man gradually developed numbness in his lower extremities. MR images revealed a tumor shadow located posterior to the spinal cord at C5-C7. Small signal void shadows were continuously observed from C1 to C5 in the region cranial to the tumor, indicating the presence of enlarged vessels. Under microscopic observation, the tumor with accompanying vessels was resected totally via hemilaminectomy. The postoperative course was uneventful, and MR images obtained 4 months after the operative procedure demonstrated total removal of the tumor and the abnormal vessels. In this case, recognizing the abnormally enlarged vessels outside the tumor mass preoperatively led us to the correct diagnosis on MR images.     

Prospective study on the risk of hepatocellular carcinoma among hepatitis C virus-positive blood donors focusing on demographic factors, alanine aminotransferase level at donation and interaction with hepatitis B virus

The risk for hepatocellular carcinoma (HCC) among asymptomatic hepatitis C virus (HCV) carriers is not well understood. A community-based prospective study was conducted for over 8 years by record linkage to the Osaka Cancer Registry. The subjects were 1,927 individuals who were positive for anti-HCV through screening for second-generation HCV antibody (passive hemagglutination assay: >or= 2(12)) in voluntary blood donation. The risk factors for HCC and interaction between HCV and hepatitis B virus (HBV) infection were evaluated by including additional blood donors: 2,519 individuals positive for hepatitis B virus surface antigen (HBsAg) alone, 25 positive for both anti-HCV and HBsAg, 150,379 negative for both anti-HCV and HBsAg. The incidence of HCC (/10(5) person-years) among the HCV-positive individuals increased with age in both genders, ranging from 68 to 1,306 among those aged 45-74 years. In the HCV-positive individuals, the cumulative risk of developing HCC between the ages of 40 and 74 year was 21.6% among males and 8.7% among females. A stepwise increase in risk was noted as the serum alanine aminotransferase level increased or serum cholesterol level at baseline decreased in multivariate Cox proportional hazard analysis. The 9-year cumulative incidence of HCC among individuals positive for HCV alone, those positive for HBsAg alone and those positive for both was 3.0%, 2.0% and 12.0%, respectively. The age-and-sex-adjusted rate ratio was 126, 102 and 572, respectively, when those negative for both were used as a reference. The results demonstrate an increased risk for HCC among asymptomatic HCV-positive individuals in Japan. Coinfection with HBV and HCV carried a superadditive risk for HCC.     

The efficacy of Shakuyaku-Kanzo-to for peripheral nerve dysfunction in paclitaxel combination chemotherapy for epithelial ovarian carcinoma

Shakuyaku-Kanzo-to was first medicated for muscular pain which was called Komuragaeri, and it has been reported that it is effective for peripheral nerve dysfunction such as arthralgia and numbness. Recently, Paclitaxel (T) and Carboplatin (J) combination chemotherapy (TJ chemotherapy) has been a standard first-line chemotherapy for epithelial ovarian carcinoma. For the arthralgia and muscular pain occurring in TJ chemotherapy, non-steroid-anti-inflammatory drugs (NSAIDs), Vitamin B12 (VB12) and Shakuyaku-Kanzo-to are the major medications. In this study, we examined twenty-one cases in which arthralgia and muscular pain occurred in TJ chemotherapy (including 16 cases as first-line chemotherapy). In all cases, patients took 7.5 g of Shakuyaku-Kanzo-to orally per day for eight days. We investigated the efficacy of Shakuyaku-Kanzo-to retrospectively with the following results. In nine cases (43%), Shakuyaku-Kanzo-to was effective in reducing pain. Especially in TJ chemotherapy as first-line chemotherapy, Shakuyaku-Kanzo-to was even more effective in reducing pain. We suggested that Paclitaxel combination chemotherapy with Shakuyaku-Kanzo-to taken orally is a more safe and tolerable way to reduce pain in epithelial ovarian carcinoma.     

Chronic administration of single weekly paclitaxel in heavily pretreated ovarian cancer patients

Ovarian cancer patients with paclitaxel-resistance have been reported to respond to a weekly schedule of the same drug. In this report, two cases with long progression free interval by weekly paclitaxel (T) are presented. Case 1. A 41-year-old Japanese woman, gravida 2, para 0, was referred to our hospital in September 16, 1998, because of abdominal mass accompanying large amount of ascites with elevated CA125 (8400 U/ml) and CA19-9 (770 U/ml). Exploratory laparotomy (tumor biopsy plus partial omentectomy) was performed September 21, 1998. After the surgery, the tumor was diagnosed as serous cystadenocarcinoma of the ovary (stage IV) and 6 cycles of treatment consisting of cyclophosphamide, adriamycin and cisplatin (CAP) were performed. The CA 125 level (8400 U/ml) rapidly declined to 150 U/ml by this CAP therapy. After second cytoreductive surgery (SRS) (total hysterectomy and bilateral salpingo-oophorectomy), residual tumor was less than 2 cm. Although 7 cycles of CAP was added, ascites and elevation of CA 125 (5100 U/ml) were observed. Therefore, treatment with single weekly T was performed and CA 125 levels remained between 70-90 U/ml during 13 cycles of this therapy (progression free interval; more than 1 year). Thereafter, she is alive with disease and followed-up. Case 2. A 48-year-old Japanese woman, gravida 3, para 2, was referred to our hospital in July 22, 1998, because of abdominal swelling and pain. Computing tomography (CT) and magnetic resonance imaging (MRI) revealed large amount of ascite and pelvic mass (9 x 7 x 7 cm), and low density area (3 x 3 cm) suggesting metastasis in right lobe of liver. Serum CA 125 level elevated to 5100 U/ml. Bilateral salpingo-oophorectomy and infracolic omentectomy were performed on August 5, 1998. The tumor was diagnosed as endometrioid adenocarcinoma of the ovary, stage IV and chemotherapy with CAP was initiated on September 5, 1998. After 6 cycles of CAP, SRS was performed. After SRS, 3 cycles of CAP were added and changed to weekly T because of damage of renal function. The CA 125 level returned within normal range during weekly T. Total 13 cycles of weekly T were performed and progression free interval was about 18 months. Thereafter, she received treatments with gamma knife and CAP for brain metastasis. She is alive without disease and followed-up. Side effects by weekly T were mild and tolerable despite of long term treatment. In addition, weekly T can be safely used in outpatient setting and even in patients with poor performance status (PS), and warrant long time to progression.     

Blue nevus of the endometrium.

A 36-year-old woman with a long history of amenorrhea underwent endometrial curettage. An aggregate of short spindle cells containing a finely granular, dark brown pigment with the histochemical characteristics of melanin was detected in the endometrial stroma. This finding is considered analogous to the occurrence of similar cells in the endocervical stroma and is most appropriately designated a "blue nevus" of the endometrium. The occurrence of nonneoplastic, melanin-laden cells in the endometrial stroma is an extremely rare phenomenon, which has been reported only once previously.     

Identification of virulence-associated antigens and plasmids in Rhodococcus equi from patients with acquired immune deficiency syndrome and prevalence of virulent R. equi in soil collected from domestic animal farms in Chiang Mai,Thailand

The prevalence of virulent Rhodococcus equi in soil collected from 17 domestic animal farms (from 12 cattle, 1 pig, and 4 horse farms) and in 6 clinical specimens from patients with acquired immune deficiency syndrome (AIDS) in Chiang Mai, Thailand, was investigated. The isolates were tested for the presence of 15-17-kDa antigens (VapA) and a 20-kDa antigen (VapB) by immunoblotting and for the presence of virulence plasmid DNA. Rhodococcus equi was isolated from most soil samples (68 of 80) obtained from the 17 farms, with 2.0 x 10(2) to 6.0 x 10(5) colony-forming units per gram of soil. We detected VapA in none of the 537 isolates from the soil samples. In one isolate from a pig farm, both VapB and virulence plasmid DNA were detected. Of the 6 clinical isolates from patients with AIDS, however, 4 isolates contained both VapB and virulence plasmid DNA. The remaining 2 isolates were avirulent.     

Kinematics of the patella in deep flexion. Analysis with magnetic resonance imaging

BACKGROUND: Little information is available on the kinematics of the normal knee in deep flexion. The purpose of this study was to use magnetic resonance imaging to analyze the patellofemoral articulation in deep flexion. METHODS: Axial scans were made of the patellofemoral joint of twenty healthy Japanese volunteers with the knee in approximately 90 degrees of flexion, in maximum active flexion (mean [and standard deviation], 140 degrees +/- 10 degrees ), and in maximum passive flexion (mean, 156 degrees +/- 5 degrees ). A fat-suppressed, three-dimensional, fast low-angle shot sequence was used to visualize the articular cartilage. The patellofemoral contact area was determined on sequential images and was reconstructed three-dimensionally. RESULTS: At 90 degrees of flexion, the contact area on the patella was continuous over the medial and lateral facets in fourteen knees and was located in the proximal half of the articular surface. At maximum active and passive flexion, the odd facet engaged in fifteen and eighteen knees, respectively. At maximum passive flexion, the contact area of the lateral facet moved distally and decreased significantly (p = 0.0002). From 90 degrees of flexion to maximum active flexion, the mean total contact area remained constant (3.43 +/- 0.70 and 3.62 +/- 0.72 cm (2), respectively); it then decreased significantly in maximum passive flexion (2.96 +/- 0.78 cm (2), p = 0.04). CONCLUSIONS: The contact area on the patella was divided into two parts (the odd and lateral facets) and moved distally in deep knee flexion. The size of the contact area on the lateral facet significantly decreased in maximum passive flexion.     

Assessment of left ventricular diastolic function by gated single-photon emission tomography: comparison with Doppler echocardiography

Gated single-photon emission tomography (SPET) is not yet an established procedure for the evaluation of left ventricular (LV) diastolic function. This study examined diastolic function derived from gated SPET in comparison with an established diagnostic tool, Doppler echocardiography. We examined 37 consecutive patients with normal sinus rhythm who underwent gated technetium-99m tetrofosmin SPET. A gated SPET program was used with a temporal resolution of 32 frames per R-R interval. We obtained the Doppler transmitral flow velocity waveform immediately before gated SPET image acquisition. Patients who showed a ratio of peak early transmitral flow velocity to atrial flow velocity (E/A) of >1 or whose R-R intervals differed by >5% between Doppler echocardiography and gated SPET were excluded from this investigation. We compared diastolic indices and presumed corresponding intervals in diastole using the two methods. The peak filling rate (PFR) derived from gated SPET correlated with the Doppler peak velocity of the early transmitral flow (E) wave (r=0.65) and deceleration of the E wave (r=0.71). The time to PFR and percent atrial contribution to LV filling from gated SPET correlated excellently with the Doppler LV isovolumic relaxation time (r=0.93) and the E/A ratio (r=–0.85), respectively. There was a significant linear correlation in all the intervals from the R wave to the presumed corresponding diastolic points. The point of PFR in gated SPET and the peak of the E wave in Doppler echocardiography generally coincided. The onset of filling in gated SPET tended to be closer to the second heart sound than the start of the E wave in Doppler echocardiography. We conclude that gated SPET permits the assessment of not only myocardial perfusion and LV systolic function but also diastolic function, although there may be some errors in detection of the precise beginning of LV filling.