Jaundice and Renal Failure Following Radical Surgery for Cancer: An Analysis of Five Autopsied Cases

An analysis of postoperative jaundice and renal failure in fiveautopsied cases is presented. Two patients had total resectionof esophageal cancer, one had a subtotal gastrectomy, and theother two had radical operations for urinary bladder carcinoma.Halothane was used for anesthesia for three patients, and allfive required blood transfusions. Postoperatively, jaundiceand azotemia developed between the 1st and 7th days, with deathsix to 10 days after surgery. Total bilirubin ranged from 1.5to 13.4mg/dl despite the normal or modest rise in hepatic enzymes.BUN varied from 46 to 288 mg/dl. Pre- and postoperative ECGrevealed a prolongation of QTc in all cases. At autopsy, theliver, kidneys and heart showed a definite increase in weight.The salient hepatic pathology included diffusely dilated spaceof Disse, centrilobular bile stasis and steatosis. This, alongwith acute tubular necrosis confirmed at autopsy, was thoughtto be due to ischemia. Although the significance of prolongedQTc remains uncertain, it is worthy of attention as one of thepreoperative checks.     

Exencephaly induction by valproic acid in the genetic polydactyly/arhinencephaly mouse, Pdn/Pdn

Non-treated homozygous polydactyly/arhinencephaly (Pdn/Pdn) mouse fetuses exhibited exencephaly in 16.7% of cases. Treatment of Pdn/Pdn mice with 350 mg/kg of valproic acid (VPA) on days 8.5 and 9.5 of gestation increased the rate of exencephaly to 66.7%. The responsible gene for the Pdn mouse phenotype has been determined to be Gli3, and the suppression of Gli3 gene expression has been documented in Pdn/Pdn embryos. We investigated how the sonic hedgehog (Shh) and Fgf8 genes, the correlated genes of Gli3, are expressed in the VPA-treated exencephalic Pdn/Pdn embryos on day 10 of gestation, using whole mount in situ hybridization (WISH) and real-time PCR methods. We could not detect any alterations in Shh expression by real-time PCR, or WISH in the non-treated Pdn/Pdn and VPA-treated exencephalic Pdn/Pdn embryos. Altered Fgf8 expression patterns were observed in the commissural plate and dorsal isthmal neuroepithelium in the non-treated Pdn/Pdn embryos. We speculated that the altered expression of Fgf8 might be the result of down-regulation of Gli3 in Pdn/Pdn embryos. Fgf8 gene expression in the commissural plate and dorsal isthmal neuroepithelium exhibits wide or altered signal patterns in the VPA-treated exencephalic Pdn/Pdn embryo. From these findings, it was suggested that down-regulation of Gli3 gene expression induced the altered expression of Fgf8 in the Pdn/Pdn embryos, and that VPA treatment accelerated the alterations of Fgf8 gene expression in the Pdn/Pdn embryos. It was further speculated that altered expression of Fgf8 in the commissural plate may be the fundamental cause of exencephaly, and that the synergistic effect between gene and drug shown in this experiment may explain the differences of sensitivity in the side-effects of the drug.     

Chronic lithium treatment decreases tau lesions by promoting ubiquitination in a mouse model of tauopathies

Lithium, a widely used drug for treating affective disorders, is known to inhibit glycogen synthase kinase-3 (GSK-3), which is one of the major tau kinases. Thus, lithium could have therapeutic benefit in neurodegenerative tauopathies by reducing tau hyperphosphorylation. We tested this hypothesis and showed that long-term administration of lithium at relatively low therapeutic concentrations to transgenic mice that recapitulate Alzheimers disease (AD)-like tau pathologies reduces tau lesions, primarily by promoting their ubiquitination rather than by inhibiting tau phosphorylation. These findings suggest novel mechanisms whereby lithium treatment could ameliorate tauopathies including AD. Because lithium also has been shown to reduce the burden of amyloid- pathologies, it is plausible that lithium could reduce the formation of both amyloid plaques and tau tangles, the two pathological hallmarks of AD, and thereby ameliorate the behavioral deficits in AD.     

Feasibility study of imaging of intraductal papillary mucinous tumors of the pancreas based on integral photography

BACKGROUND/AIMS: The principle of integral photography was first proposed by Lippman in 1908. Recently, the three-dimensional display system based on the principle of integral photography was developed. It projects three-dimensional objects using a lens array called a fly's eye lens and photographic film. Some groups have used it for surgical navigation in brain surgery. In this study, we tried to generate integral photographic images of intraductal papillary mucinous tumors of the pancreas, and evaluated the feasibility of this method. METHODOLOGY: Five patients with an intraductal papillary mucinous tumor of pancreas were studied. We used MRI data as three-dimensional data. MRI data were acquired with a 1.5-T clinical imager (Signal.5; GE Medical Systems, U.S.A). We used multi-slab single-shot fast spin-echo sequences. Section thickness was between 2 and 3mm in the coronal plane. From these data, integral photographic images were generated on a liquid crystal display by a three-dimensional rendering algorithm. RESULTS: Three-dimensional images using the principle of integral photography could be generated in all 5 cases. We could recognize these images as three-dimensional images by slightly moving the viewpoint to up, down, left, and right. From these images, we were able to grasp the three-dimensional relationship between the tumor, bile duct, and pancreatic duct. Using these three-dimensional images, a variety of minimally invasive surgical procedures were performed for intraductal papillary mucinous tumor of the pancreas, more safely and speedily than formerly. CONCLUSIONS: The images based on integral photography are suitable for medical imaging and are useful for surgical planning.     

Effects of cetirizine on substance P release in patients with perennial allergic rhinitis

To evaluate the effect of cetirizine hydrochloride on substance P release in allergic rhinitis, we performed a single-blind placebo-controlled study of 14 patients with perennial allergic rhinitis (7 treated with cetirizine and 7 with placebo). After an initial nasal allergen challenge with lavages, the subjects received treatment with placebo or cetirizine hydrochloride (10 mg by mouth daily) for 1 week, followed by the second nasal allergen challenge with lavages. The levels of albumin, histamine, and substance P in nasal lavages before and after allergen challenge were quantified by enzyme-linked immunosorbent assay. Pretreatment of subjects with cetirizine reduced the level of substance P induced by antigen challenge, but did not significantly reduce levels of histamine. These results suggest that cetirizine may reduce nasal neurogenic inflammation by modulating the release of substance P in allergic rhinitis.     

Existential concerns of terminally ill cancer patients receiving specialized palliative care in Japan

Background Although alleviation of existential distress is important for terminally ill cancer patients, the concept of existential distress has not been fully understood. The aim of this study was to categorize existential concerns of Japanese terminally ill cancer patients and explore care strategies based on the categorizations.Methods A multicenter cross-sectional study in 88 terminally ill cancer patients receiving specialized inpatient palliative care was performed. The nurses explored patient existential concerns by asking several key questions, and recorded the answers that they considered typically described the patients concerns. All statements recorded by the nurses were analyzed using content analysis methods.Results A total of 89 statements were subjected to analysis. The categories and their prevalence were: relationship-related concerns (22%; isolation, concerns about family preparation, conflicts in relationship), loss of control (16%; physical control, cognitive control, control over future), burden on others (4.5%), loss of continuity (10%; loss of role, loss of enjoyable activity, loss of being oneself), uncompleted life task (6.8%), hope/hopelessness (17%), and acceptance/preparation (25%).Conclusions Existential concerns of Japanese terminally ill cancer patients were categorized as relationship-related concerns, loss of control, burden on others, loss of continuity, uncompleted life task, hope/hopelessness, and acceptance/preparation. These themes seemed to encompass universal human suffering beyond cultural differences, and this conceptualization may contribute to the development of effective therapeutic interventions to alleviate existential distress.This is work is presented on behalf of the Japan Pain, Rehabilitation, Palliative Medicine, and Psycho-Oncology (J-PRPP) Study Group.The study was supported by Health and Labor Sciences Research Grants, Clinical Research for Evidenced Based Medicine (2002).     

Preventive and curative effects of acupuncture on the common cold: a multicentre randomized controlled trial in Japan

OBJECTIVE: To determine the preventive and curative effects of manual acupuncture on the symptoms of the common cold. METHOD: Students and staff in five Japanese acupuncture schools (n=326) were randomly allocated to acupuncture and no-treatment control groups. A specific needling point (Y point) on the neck was used bilaterally. Fine acupuncture needles were gently manipulated for 15 s, evoking de qi sensation. Acupuncture treatments were performed four times during the 2-week experimental period with a 2-week follow-up period. A common cold diary was scored daily for 4 weeks, and a common cold questionnaire was scored before each acupuncture treatment and twice at weekly intervals. A reliability test for the questionnaire was performed on the last day of recording. RESULTS: Five of the 326 subjects who were recruited dropped out. The diary score in the acupuncture group tended to decrease after treatment, but the difference between groups was not significant (Kaplan-Meier survival analysis, log rank test P=0.53, Cox regression analysis, P>0.05). Statistically significantly fewer symptoms were reported in the questionnaire by the acupuncture group than control group (P=0.024, general linear model, repeated measure). Significant inter-centre (P<0.001, general linear model) and sex (P=0.027, general linear model) differences were also detected. Reliability tests indicated that the questionnaire with 15 items was sufficiently reliable. No severe adverse event was reported. CONCLUSION: This is the first report of a multi-centre randomized controlled trial of acupuncture for symptoms of the common cold. A significantly positive effect of acupuncture was demonstrated in the summed questionnaire data, although a highly significant inter-centre difference was observed. Needling on the neck using the Japanese fine needle manipulating technique was shown to be effective and safe. The use of acupuncture for symptoms of the common cold symptoms should be considered, although further evidence from placebo controlled RCTs is required.     

Negative growth control of renal cell carcinoma cell by connexin 32: possible involvement of Her-2

Connexin (Cx) genes have negative growth effects on tumor cells with certain cell specificity. We have previously reported that Cx32 is specifically downregulated in human renal cell carcinoma cell (RCC) lines as well as cancerous regions of kidneys and that the Cx is expressed in the progenitor cells of the carcinoma. However, the precise role of Cx32 in growth control of RCC cells remains unknown. In this study, we examined whether Cx32 could act in growth control against a human RCC cell, Caki-2 cell. In order to estimate the cell growth control, we established Caki-2 cells that have stable expression of Cx32 genes. Cx32 expression in Caki-2 cells induced contact inhibition of growth and reduced anchorage-independent growth ability, but did not significantly affect lag phase growth rates. This growth control by Cx32 was dependent on the inhibition of the cell-cycle transition from G1 to S phase at high cell density, and the inhibition of the cell-cycle transition related to the suppression of Her-2 activation. Furthermore, the suppression of Cx32 expression in Caki-2 cells by short interfering RNA induced the activation of Her-2. These data suggest that Cx32 has negative growth control of Caki-2 cells, partly due to the inhibition of the Her-2 activation.     

Ulcerative colitis occurring in the course of rheumatoid arthritis: a case successfully treated with mesalamine enema

We report a case of ulcerative colitis (UC) that occurred during the course of rheumatoid arthritis (RA). A 29-year-old woman with a 25-year history of RA was hospitalized for high fever, abdominal pain and hematochezia. Colonoscopy revealed erosive and reddish mucosa from the distal transverse colon to rectum. Histology revealed cryptitis (mainly caused by neutrophils), mild crypt abscess and goblet cell depletion. She was diagnosed with left-sided UC and treated with mesalamine enema. The abdominal symptoms and colonoscopic findings were greatly ameliorated. We conclude that the mesalamine enema was effective in this case of UC occurring during the course of RA.