Macroscopic and histotopographic study of the deep transverse perineal muscle (musculus transversus perinei profundus) in elderly Japanese

Although the deep transverse perineal (DTP) muscle is welt known as the core of the urogenital diaphragm, most recent studies have denied its existence. In students' dissection classes, we cut the surfaces of 93 macroscopically identified urogenital diaphragms (59 male cadavers) and found the distinct sheet-like DTP in 24.7% (23 of 93 sides). Another 17 cadavers (mean age 81.4 years) were used for histology. In histology of 12 males, we consistently identified the DTP as a small muscle bundle immediately lateral to the bulbourethral gland. Thus, the macroscopicically unclear morphology of the DTP (19.4%, 18 of 93 sides) seemed to be overestimated. The histologically proven DTP was continuous with a "tail" or inferolateral protrusion of the external urethral sphincter or urethral rhabdospincter. However, the histology revealed that a sheet-like DTP was not usual (16.7%, two of 12 cadavers). Likewise, in histology of five females, the tail always continued to a muscle mass immediately lateral to the greater vestibular gland and far dorsal to the external urethral sphincter. Thus, the female topohistology seemed to be consistent with the male unclear DTP. Because of the limited incidence of a sheet-like DTP and the unclear fascial structure containing numerous vessels around the rather small DTP, in most elderly cadavers the urogenital diaphragm was likely to be a macroscopic entity rather than a histologic one. However, we believed that the histologically proven DTP was present in elderly men and women even if it had changed as a result of degeneration with aging.     

Sleep of 4-month-old infants: bedtime, night waking and sleep problems

BACKGROUND AND OBJECTIVES: Recently, Japanese infant's bedtime has become late and it is reported that this might have a bad influence on infant's growth. The purpose of the present study was to investigate the actual situation and interrelationships between night waking and other sleep problems in Japanese 4-month -old infant. METHODS: The subjects were 194 mothers and infants who participated in health checkups at four months after delivery in Fukuoka City. The questionnaire consisted of 3 components: 1) infant's and mother's sleep practices and sleep problems; 2) coping behavior for infant's sleep; 3) perceptions of child-care and maternal health. Their responses were linked to health checkup's results. The subjects were divided into two groups; Waking Group (n = 111) who was wakening one or more times from 0-6 a.m. and Sleeping Group (n = 83) who was sleeping throughout the night. The proportion of Waking Group was constituted 57.2% in all infants. Infant's growth, sleep, and sleep problems were compared between two groups. RESULTS: The mean infant's bedtime was 10:28 p.m., and the proportion of infants reported to go to bed at 10 p.m. or later was 69.4%. The proportion of infants with irregular bedtimes was 16.5%. Twenty-eight point six percent of infants had sleep problems like difficulty settling, severe night waking and were suspected to be high risk of sleep disorders. Infants in the Waking Group were found to have more numbers of sleep problems than in the Sleeping Group. The proportion with difficulty settling was higher in the Waking Group. Additionally, the proportion with irregular bedtimes was higher in the Waking Group. However, infant's height and weight did not significantly differ between two groups. CONCLUSIONS: Late bedtime and high proportion of night waking in 4-month-old infants were found to be characteristic in Fukuoka city. There is a possibility that night waking reflects delayed development of circadian rhythms.     

Characterization of naturally occurring protease inhibitor-resistance mutations in genotype 1b hepatitis C virus patients

Background and aims

Protease inhibitor (PI)-resistant hepatitis C virus (HCV) variants may be present in substantial numbers in PI-untreated patients according to recent reports. However, influence of these viruses in the clinical course of chronic hepatitis C has not been well characterized.

Methods

The dominant HCV nonstructural 3 (NS3) amino acid sequences were determined in 261 HCV genotype 1b-infected Japanese patients before pegylated interferon plus ribavirin (PEG-IFN/RBV) therapy, and investigated the patients?? clinical characteristics as well as treatment responses including sustained virological response (SVR) rate. HCV-NS3 sequences were also determined in 39 non-SVR patients after completion of the therapy.

Results

Four single mutations (T54S, Q80K, I153V, and D168E) known to confer PI resistance were found in 35 of 261 patients (13.4%), and double mutations (I153V plus T54S/D168E) were found in 6 patients (2.3%). Responses to PEG-IFN/RBV therapy did not differ between patients with and without PI-resistance mutations (mutation group, SVR 48%; wild-type group, SVR 40%; P?=?0.38). On the other hand, two mutations appeared in two non-SVR patients after PEG-IFN/RBV therapy (I153V and E168D, 5.1%).

Conclusions

PI-resistance-associated NS3 mutations exist in a substantial proportion of untreated HCV-1b-infected patients. The impact of these mutations in the treatment of PIs is unclear, but clinicians should pay attention to avoid further development of PI resistance.     

A case of AA amyloidosis associated with rheumatoid arthritis effectively treated with Infliximab

We report the case of a 55-year-old Japanese woman with reactive AA amyloidosis associated with rheumatoid arthritis, in which inflammatory disease was completely suppressed with infliximab. Nephrotic syndrome was observed and renal biopsy specimens revealed amyloidosis deposits. Treatment with infliximab normalized the serum amyloid A (SAA) protein level, and subsequently nephritic syndrome disappeared and her creatinine clearance improved. Serial gastrointestinal biopsy specimens showed marked lasting regression of amyloid deposits. Thus treatment with infliximab represents an important therapeutic strategy for AA amyloidosis associated with RA.     

Comparison of four diagnostic methods using clinical blood by measuring (1-->3)-beta-D-glucan

Using Amebocyte lysate of horseshoe crab to measure (1-->3)-beta-D-glucan specifically, a component of the cell wall, several kinds of diagnostic methods for deep mycosis are in practical use in Japan. However, the most important problem is that the judgment of positive or negative is method dependent. To elucidate the cause of the problem, each measurement value of the identical sample by four methods, beta-Glucan Test Maruha (MARUHA), beta-Glucan Test Wako (WAKO). FUNGITEC G Test (FUNGITEC-G) and FUNGITEC G Test MK (FUNGITEC-MK) was compared with the clinical data using 119 cases and 289 tests. Each case was divided into three groups; proven fungal infection, probable fungal infection and non-fungal infection. The negative cases for all the methods tested in the groups of proven fungal infection and probable fungal infection were allergic bronchopulmonary aspergillosis and cryptococcosis, and that for all the methods tested except FUNGITEC-MK method in the group was pulmonary aspergilloma. It seems that these cases cannot be detected correctly by only measuring (1-->3)-beta-D-glucan. On the other hand, the ratio of false positive, positive for non-fungal infection group was high in the case of FUNGITEC-MK. About 23% against the total case was positive for FUNGITEC-MK method, but negative for MARUHA, WAKO, and FUNGITEC-G methods. Although the difference of the sensitivity among four methods was not observed, the specificity, the diagnostic efficiency, and the positive predictive value of FUNGITEC-MK method were remarkably lower than those of the other methods due to false positive measurement. In conclusion, MARUHA, WAKO and FUNGITEC-G except FUNGITEC-MK is not method dependent. It is suggested that FUNGITEC-MK detects non-specific reaction resulted in false positive.     

Obstructive jaundice due to internal herniation: a case report and review of the literature

A 45-year-old man was suffering from abdominal pain and vomiting. He was admitted to our hospital with a diagnosis of ileus and obstructive jaundice. He had undergone Roux-en-Y anastomosis for choledocholithiasis 14 years earlier. A computed tomography scan revealed a dilated afferent loop and dilated intrahepatic bile duct. Upper gastrointestinal examination with contrast medium and percutaneous transhepatic cholangiography showed a high intestinal obstruction around the jejunojejunal anastomosis. The patient underwent laparotomy based on a diagnosis of obstructive jaundice due to ileus. During the operation, he was found to have internal herniation of the small bowel through a rent in the mesentery around the Roux-en-Y anastomosis for choledochojejunostomy. The hernia was reduced, and bowel resection was performed due to stenosis of the afferent loop. Jejunojejunal anastomosis was re-performed and the defect in the mesocolon was closed. Internal herniation after Roux-en-Y anastomosis is a rare sequela, but it should be recognized that this complication can occur after Roux-en-Y anastomosis. For prevention of internal herniation around the Roux-en-Y limb, secure closing of the mesenteric defects is important.     

Two cases in which an abnormal hemoglobin (Hb Kamakura) was identified on the basis of an abnormally low glycohemoglobin levels

We encountered two patients with abnormally low glycohemoglobin levels in spite of normal plasma glucose levels. Since the presence of an abnormal hemoglobin was suggested by high-performance liquid chromatography (HPLC), gene analysis of these two patients was conducted by single-strand conformation polymorphism (SSCP) analysis followed by direct sequencing, and Hb Kamakura with one base substitution (beta3 Leu --> Val) in the beta globin gene was detected in both patients. There was been only one report of Hb Kamakura in Kanagawa Prefecture, and our patients represent the second and third cases, respectively.     

Difference in mesothelin‐binding ability of serum CA125 between patients with endometriosis and epithelial ovarian cancer

The epithelial ovarian carcinoma (EOC) is an aggressive malignant tumor, and is currently the leading cause of gynecologic cancer death. CA125 is the most commonly used serum marker for EOC, but shows a high‐false‐positive rate for several benign diseases such as endometriosis. The purpose of our study is therefore to identify a useful biochemical tool for detecting qualitative differences between CA125 from patients with endometriosis and EOC, and to facilitate differential diagnosis of these diseases. In our study, using two different CA125‐binding molecules, i.e., recombinant mesothelin and an anti‐CA125 monoclonal antibody, a novel sandwich ELISA for determining the serum levels of CA125 with mesothelin‐binding ability (CA125^meso) was developed, and tested for patients with endometriosis (n = 59) and EOC (n = 36). We found that both the serum CA125^meso level and the ratio of the serum CA125^meso to CA125 levels (CA125^meso/CA125) were significantly higher in patients with EOC than in patients with endometriosis (p < 0.00005 and p < 0.000001, respectively). Furthermore, receiver operating characteristic analysis showed that the CA125^meso assay was superior to the conventional antibody‐based CA125 assay in discriminating endometriosis from EOC. Thus, mesothelin‐binding ability may be a useful indicator for qualitatively evaluating CA125 in patients with endometriosis and EOC.     

Attenuating effect of castration or oestrogen administration on glomerular injury in adriamycin-induced nephropathy of rats

Summary: To clarify the role of sex-related factors in the development of focal segmental glomerulosclerosis (FSGS) we investigated the effect of castration or oestrogen administration in adriamycin (ADR)-induced nephropathy of Sprague-Dawley rats. At 6 weeks of age, group 1 (control group) and group 3 were shamoperated and group 2 was castrated. Adriamycin 2 mg/kg was administered intravenously to all rats at 8 weeks of age twice at a 20-day interval. Group 3 was administered 0.2 mg oestrogen subcutaneously once a month. Bodyweight (BW) and urinary protein were measured every 4 weeks (mm 15 to 23 weeks of age. Blood pressure and serum constituents were measured at 15 and 23 weeks of age. Each group was studied morphologically at 23 weeks of age. Adriamycin induced massive proteinuria in group 1, whereas castration or oestrogen significantly attenuated proteinuria, accompanied by a significant reduction of urinary sex-related low molecular weight (LMW) protein. the glomerulosclerosis index was significantly higher in the control group than in the castrated group or oestrogen-treated group. Attenuation in glomerular injury was more associated with reduction of urinary sex-related LMW protein than the reduction of serum testosterone. These observations suggest that sex-related factors, such as a sex-related LMW protein, influenced by castration or oestrogen administration may play a contributory role in the development of glomerulosclerosis in ADR-induced nephropathy.