Liver and Bone

Abstract  To investigate the pathogenesis of hepatic osteodystrophy (HOD) in parenchymal liver disease, we developed a laboratory model in animals using carbon tetrachloride (CCl₄) and thioacetamide. Biochemical and histological parameters in the model were measured. In rats with both chronic non-cirrhotic liver injury and CCl₄-induced cirrhosis, tibial bone volume was significantly lower than in controls. In CCl₄-treated cirrhotic rats, the osteoid volume decreased while the urinary calcium/creatinine ratio increased. In all CCl₄-treated rats, bone volume was significantly correlated with both the serum albumin concentration and the number of goblet cells reflecting intestinal villous atrophy. The serum concentration of vitamin D metabolites was not correlated with bone volume. Whole body retention of ⁴⁷Ca was significantly lower in CCl₄-treated cirrhotic rats than in controls. Furthermore, the bone volume in thioacetamide-treated cirrhotic rats was significantly lower than in controls. These data demonstrate that chronic parenchymal liver injury itself causes osteoporosis (i.e. HOD) due to a combination of low bone formation rates and high resorption rates, that HOD begins at the stage of chronic non-cirrhotic liver injury, that bone volume in HOD parallels liver damage and that the principal pathogenesis of HOD seems to be intestinal Ca malabsorption due to lower serum albumin and villous atrophy, while serum levels of vitamin D metabolites have little influence on the pathogenesis of HOD.     

Partial trisomy for short arm of chromosome 5

We present two unrelated cases of partial trisomy for the short arm of chromosome 5, the first such cases reported in Japan. The features are characterized by hypertelorism, low set ears, arachnodactyly, laryngostenosis, hypotonia and some cerebral malformation. The characteristic facial expression and arachnodactyly are the key features used to diagnose this disorder. A high-resolution chromosome banding technique showed that the karyotype of the first patient was 46, XX, inv dup(5) (p13.1 ← p15.3) de novo and that of the second patient was 46, XX, dir dup(5) (p13.3 ← p15.2) de novo. The similar symptoms in the two cases, despite the difference in karyotypes, were caused by duplication of 5p including segment 5p13. This would be a key site for this disorder.     

Update on Cutting Balloon Angioplasty

Cutting balloon (CB) is a unique balloon catheter with 3 or 4 metal blades on its surface making controlled endovascular surgical incisions that show promise of causing less vessel wall injury and less intimai proliferation. Multicenter randomized trials have revealed that CB angioplasty with multiple inflations achieved better lumen enlargement than single inflation and reduced coronary dissection more than plain old balloon angioplasty (POBA). Follow-up results showed CB angioplasty had a smaller late loss and loss index, resulting in lessened restenosis and target lesion revascularization rates. The main indication of CB angioplasty is basically a noncalcified lesion with concentric plaque; however, it could be applied effectively to some lesions unsuitable for POBA including in-stent restenosis, small vessel, long diffuse lesion, or ostial lesion. Additional evaluation would be necessary to determine the role of CB angioplasty in the stent era.     

Relationship between odor perception and depression in the Japanese elderly

Abstract Odor perception has been studied in patients with various mental disorders; however, no consensus has been reached as to its detection, identification, or pleasantness/unpleasantness of odors especially in patients with depression. One hundred and nineteen normal elderly individuals living at home were exposed to odors of rose, perfume, white ginger, Indian ink, cigarette smoke, milk, feces and orange scent using the scratch and sniff method. They were asked to rate the strength of each odor, its pleasantness or unpleasantness, their liking for it, and their familiarity with it. They were also asked to complete a self-rating depression scale (SDS). The relationship of the score of each psychological olfactory scale with the SDS score and the difference in the score of each psychological scale between high-SDS and low-SDS groups are discussed.     

Results of Radiotherapy in the National Cancer Center Hospital--Second Report of the National Cancer Center Radiotherapy Computer System

Results of radiotherapy in the National Cancer Center Hospitalduring 1962–1970 were analysed by using the National CancerCenter Radiotherapy Computer System which had been developedby the authors. More than a half of the total cancer cases treatedin the hospital were given some kind of radiotherapy. The overallfive-year survival rate of radiotherapy cases corrected witha life table method were 38.4% for total cases, 44.6% for radicallytreated cases and 14.6% for palliatively treated cases. Combinedtreatment by radiation and surgery showed better results suchas 48.3% for preoperative and 57.8% for postoperative radiotherapycases. The following factors were analysed in terms of the five-yearsurvival rate: age, sex, stage, histology and double-primarycancer. In general, female cases showed much better prognosis than thatof male cases. Five-year survival rate showed its peak at 30–40years of age and was low at lower or higher ages. Inverse correlationshipsby age were observed between the incidence of cancer and thesurvival rate after treatment, and the value of correlationcoefficient was larger in males and smaller in females. The age dependency of incidence and prognosis of cancer stronglysuggested the important role of host resistance in the treatmentand prevention of cancer. ^*Present address: National Institute of Radiological SciencesChiba ^**Present address: Chiba Cancer Center Hospital hiba     

Small Cell Lung Carcinoma with Ectopic Adrenocorticotropic Hormone and Antidiuretic Hormone Syndromes: A Case Report

This report describes a 63-yr-old man with lung cancer accompanyinghypertension, hyperpigmentation, muscle weakness, psychosis,hypokalemia, hyperglycemia, hyponatremia, massive naturesisand lower serum osmolality than urine osmolality. Elevated levelsof plasma and urine corticosteroids and of plasma immunoreactiveadrenocorticotropic hormone (ACTH) were not altered by the administrationof large amounts of dexamethasone. Elevated plasma antidiuretichormone (ADH) values were also demonstrated. Postmortem examinationsrevealed small cell lung carcinoma with extensive metastasis,bilateral adrenocortical hyperplasia and Crooke's degenerationof the pituitary gland. Immunoradiological and immunohistochemicalstudies demonstrated the presence of immunoreactive ACTH, ADHand gastrin-releasing peptide in the tumor tissue. Beta-melanocyte-stimulatinghormone, calcitonin and carcinoembryonic antigen were also detectedby one of the methods. Hence, this is a rare case of lung cancerwith multiple hormone production and clinical and laboratoryevidence of both the ectopic ACTH and ADH syndromes. ^* Present address: Department of Internal Medicine, Keio UniversitySchool of Medicine, Tokyo, Japan     

Retrograde Supernormal Conduction, Gap Phenomenon in Concealed Accessory Atrioventricular Pathways

We present four patients with the Wolff-Parkinson-White syndrome who exhibited retrograde supernormal conduction or gap phenomenon in concealed accessory pathways. In the first patient, ventricular extrastimulus testing revealed retrograde block at the coupling interval of 520 msec and reappearance of conduction at the coupling interval of 370 msec. In a second patient, 1:1 retrograde conduction was not present but supernormal conduction was demonstrated at coupling intervals of 360 msec to 310 msec during the ventricular extrastimulus testing when the basic drive consisted of atrioventricular (AV) simultaneous pacing. In a third patient, ventricular extrastimulus testing demonstrated retrograde conduction through the accessory pathway only at coupling intervals of 400 msec to 360 msec. In a fourth patient, retrograde block occurred at the coupling interval of 340 msec and retrograde "slow" conduction reappeared at coupling intervals of 300 msec to 250 msec (gap phenomenon) only when the basic drive consisted of AV simultaneous pacing. Thus, concealed accessory pathways may exhibit retrograde supernormal conduction or gap phenomenon. Ventricular extrastimulus testing consisting of AV simultaneous pacing during the basic drive may facilitate demonstration of these unusual properties.     

Reliability and validity of the Japanese version of the Zarit Caregiver Burden Interview

Abstract  Despite a rapid increase in disabled elderly in Japan, the burden of the caregiver has not been properly assessed due to a lack of objective measurements. Our study was aimed at adapting and validating the Zarit Caregiver Burden Interview (ZBI) in Japan, which is one of the most widely used measurements for caregivers' burden in the United States. Sixty-six caregivers answered the self-administered questionnaire, involving the Japanese version of the ZBI and questions regarding their caregiving situation. Our study demonstrated that the Japanese version of the ZBI had equally as high reliability and validity as the original version. The Japanese ZBI had a high test—retest reliability (r = 0.76) and internal consistency (Cronbach's alpha = 0.93). The total score of the ZBI was highly correlated with the caregivers' score of the Center for Epidemiologic Studies Depression Scale (CES-D) score (r = 0.50), as well as a single global rating of burden (r = 0.71). It was also shown that demographic distribution of the score of the Japanese version had a similar trend to that of the original version. Caregivers who looked after patients with behavioral disturbances were found to have a significantly higher ZBI score than those who looked alter patients without behavioral disturbances, which is consistent with previous findings. It is concluded that the Japanese version of the ZBI can be used to measure feelings of burden of caregivers in the Japanese population and can be used for cross-cultural comparison.