Analysis of bone mineral density in urolithiasis patients

BACKGROUND: The association between hypercalciuria and bone mineral density (BMD) has been already recognized. The aim of the present study is to relate BMD to age and sex and to evaluate the calcium metabolism and hypercalciuria-defined dietary or non-dietary category in patients with urolithiasis. METHODS: The BMI of the L2-L4 lumbar vertebrae was measured in 310 renal stone patients (191 men and 119 women). Percent age matched score (%AMS), which is the percent ratio of measured BMD to the mean BMD of age-matched control subjects, was utilized for the appraisal of BMD. Low BMD groups were defined by lower than 90% of %AMS. RESULTS: Low BMD was observed in 27.7% of urinary stone patients, which was not a significant difference to that of control subjects (23.5%) who were measured in the health examination. In male patients with urolithiasis, the frequency of patients in whom BMD had been apt to decrease since youth was high, but there was not a proven significant difference among the three age groups (20-39 years old, 40-59 years old and 60 years old or older). In contrast, for female stone patients, the frequency of low BMD markedly increased in patients aged 40 years or older, when menopause occurs. Furthermore, in female stone patients with hypercalciuria, the frequency of reduced BMD reached more than 40%. When the cause was non-dietary hypercalciuria (classified mainly on the daily amount of urinary calcium excretion after ingestion of calculus test diet), the frequency of reduced BMD reached 65% (P < 0.01). CONCLUSIONS: In case female stone patients with non-dietary hypercalciuria become menopausal, not only the risk of recurrent lithiasis increases, but the possibility of developing osteopenia in the future also increases. Appropriate treatments for prophylactic effects on urolithiasis or osteopenia should be considered, as judged from BMD, diet, sex, urinary calcium excretion and other factors synthetically.     

Intestinal-type mucinous adenocarcinoma arising from the prostatic duct

We present a case of mucinous adenocarcinoma of intestinal type arising from the prostatic duct in a 72-year-old Japanese man. The patient presented with macroscopic hematuria. Cystourethroscopy exhibited a mucus deposit at the 5 o'clock position of the verumontanum portion. A transurethral biopsy specimen revealed mucinous adenocarcinoma. A radical retropubic prostatectomy was performed. In the prostatectomy specimen, the cancer lesion mainly showed intraductal growth in the prostatic ducts with scattered mucin lakes in the prostatic stroma. There were no abnormalities in the urethral epithelium. The cancer cells resembled the intestinal epithelium rather than either the prostatic duct or the acinar epithelium, which showed diffusely positive immunohistochemical staining for carcinoembryonic antigen, but showed negative staining for prostate-specific antigen. Therefore, these findings suggest mucinous adenocarcinoma of intestinal type arising from the prostatic duct. A number of cases with mucinous adenocarcinoma arising from the prostatic urethra resembling the present case have been reported, but this is the first known case of carcinoma arising from the prostatic duct.     

T cells increase with gastric mucosal interleukin (IL)-7, IL-1, and Helicobacter pylori urease specific immunoglobulin levels via CCR2 upregulation in Helicobacter pylori gastritis

Background and Aims: The purpose of this study was to investigate possible factors that could impact on γδ T cell accumulation in the gastric mucosa. Method: Subjects were 22 Helicobacter pylori (H. pylori)‐free and 75 H. pylori‐infected mucosa biopsies classified into grades I～III gastritis as per our previous study. The number of γδ‐ and 45 RO‐positive T cells were determined by immunostaining. Gastric mucosal anti‐H. pylori urease specific antibodies and interleukin (IL)‐1β, IL‐2, 4, 7, 10 and IL‐12 levels were assayed by enzyme‐linked immunosorbent assay (ELISA). CC chemokine receptor 2 (CCR2) expression levels, migration, and cytokine production in γδ T cells stimulated by H. pylori urease were also evaluated. Results: The γδ T cell count was significantly higher in grade III gastritis which exhibits strong immunoglobulin (Ig)A and IgG responses to H. pylori urease with lymphoid follicles than in other groups. γδ T cell count was significantly correlated with IL‐1β and interleukin‐7 (IL‐7) levels in the gastric mucosa. H. pylori urease immunoreactivity was detected in lamina propria of grade III gastritis, along with many γδ T cells. After H. pylori eradication therapy, the γδ T cell count in grade III gastritis significantly decreased. H. pylori urease stimulated significant increases in CCR2 expression levels, although to a lesser degree than those induced by IL‐7 stimulation in both peripheral and mucosal γδ T cells. Interferon (IFN)‐γ and IL‐10 production was also stimulated by H. pylori urease in peripheral γδ T cells. Conclusions: Gastric mucosal increases in IL‐7 and IL‐1β closely corresponded to the accumulation of γδ T cells in gastric mucosa. An association was also seen between γδ T cell accumulation and H. pylori urease‐specific Ig levels.     

Acceleration of wound contraction and healing with a photocrosslinkable chitosan hydrogel

Application of ultraviolet light irradiation to a photocrosslinkable chitosan aqueous solution resulted in an insoluble, flexible hydrogel like soft rubber within 60 seconds. In order to evaluate its accelerating effect on wound healing, full-thickness skin incisions were made on the backs of mice and subsequently a photocrosslinkable chitosan aqueous solution was added into the wound and irradiated with UV light for 90 seconds. Application of the chitosan hydrogel significantly induced wound contraction and accelerated wound closure and healing compared with the untreated controls. Histological examination also showed an advanced contraction rate on the first 2 days and tissue fill rate on days 2 to 4 in the chitosan hydrogel-treated wounds. Furthermore, in cell culture studies, chitosan hydrogel culture medium supplemented with 5% fetal-bovine serum was found to be chemoattractant for human dermal fibroblasts in an invasion chamber assay using filters coated with Matrigel and in a cell migration assay. Due to its ability to accelerate wound contraction and healing, chitosan hydrogel may become accepted as an occlusive dressing for wound management.     

Pulse oximetric thresholds for tonsillectomy and adenotomy in children: significance of 1–2% decline in oxyhemoglobin saturation

Objectives:  We aimed to establish optimal overnight pulse oximetric thresholds for determining the indication of tonsillectomy and adenotomy (TA) in children by revising the definition of 'desaturation'.
Methods:  One hundred and thirty four children scheduled for TA (TA group, 5.3 ± 1.4 years old) and 112 otherwise healthy children scheduled for elective minor surgery (control group, 5.4 ± 1.5 years old) were enrolled into this prospective study. Data were recorded and stored every 10 s using Nellcor N-395. Desaturation/resaturation events were defined as x % change ( x  = 1–4) of SpO₂ (oxyhemoglobin saturation by pulse oximetry) in 10 s. The desaturation/resaturation indices were calculated as events per hour of total sleeping time. For each index, a wide range of temporary thresholds was set. The optimal thresholds for TA were the ones that maximized the weighted average for sensitivity, specificity (based on whether the index improved or not after TA), and the percentage of the control children whose indices were below the threshold.
Results:  For all the indices, the optimal thresholds that fulfilled the above condition were determined. Compared with the x  = 3–4% results, the application of x  = 1–2% approximately doubled the TA patients whose preoperative 'positive' indices improved after TA, with the weighted averages of 84.3–92.3% as described above.
Conclusions:  By defining desaturation/resaturation as a 1–2% change in SpO₂ from the preceding value, children with adenotonsillar hypertrophy whose pulse oximetric indices are expected to improve after TA can be detected by pulse oximetry with relatively high sensitivity and specificity.     

EFFECT OF OCTAPEPTIDE SOMATOSTATIN ANALOGUE (SMS 201-995) ON PLASMA 7B2 (A NEUROENDOCRINE POLYPEPTIDE) LEVELS IN PATIENTS WITH ACROMEGALY

We studied the sequential changes of plasma levels of immunoreactive '7B2' (IR-7B2), a neuroendocrine polypeptide, after a subcutaneous injection of 50 micrograms of synthetic octapeptide somatostatin analogue (SMS 201-995) in seven patients with acromegaly due to GH-producing pituitary adenoma. Compared to the basal levels, mean plasma IR-7B2 and GH levels significantly decreased, until 5 and 10 h respectively after the administration of SMS 201-995. The mean (+/- SEM) nadir levels of plasma IR-7B2 and GH were 68.1 +/- 10.1 and 13.1 +/- 6.9%, respectively, compared to mean plasma levels before treatment (100%). Plasma IR-7B2 as well as GH levels did not change significantly when saline was administered subcutaneously to three acromegalic patients. In addition, plasma IR-7B2 levels did not change significantly after the administration of SMS 201-995 in normal subjects or in patients with primary hypothyroidism in whom SMS 201-995 induced a decrease of plasma TSH levels. These results strongly suggest that SMS 201-995 has an unequivocal suppressive effect on the synthesis and/or the secretion of 7B2 in human somatotroph adenoma cells.     

Early catheter removal 3 days after radical retropubic prostatectomy

AIM: We investigated the feasibility and safety of the early removal of urethral catheters 3 days after radical retropubic prostatectomy. METHODS: Seventy consecutive patients underwent radical retropubic prostatectomy with the intent of early catheter removal on postoperative day (POD) 3. Catheter removal was based on postoperative cystograms performed on POD 2. Patients were analyzed using a validated prostate cancer specific questionnaire (University of California, Los Angeles Prostate Cancer Symptom Index) to determine quality of life outcomes. Multiple logistic regression analysis was also used to evaluate if any of the preoperative or intraoperative parameters were able to predict the success of early catheter removal after radical retropubic prostatectomy. RESULTS: The catheter was removed on POD 3 in 67 of 70 patients (97%) excluding three patients with moderate or severe extravasation on postoperative cystograms. Of the 67 patients, 53 (76%) were successful in early catheter removal, but the remaining 14 (24%) patients experienced urinary retention within 48 h and were treated with simple catheter replacement for 1 or 2 days. Two patients developed anastomotic strictures 3 and 4 months postoperatively, which were managed by dilation alone. Multiple logistic regression analysis showed that no leak during an intraoperative leak test was the only independent predictor of success for early catheter removal (P = 0.0069; odds ratio, 6.667; 95% confidence interval, 1.682-26.428). CONCLUSION: The present study revealed that early catheter removal 3 days after radical retropubic prostatectomy is feasible in patients who show a negative intraoperative leak test. Postoperative monitoring of more patients is needed to determine if the early catheter removal is widely applicable.     

Dose-related protective efficacy of immunoglobulins in experimentally induced group B streptococcal infection

This study investigates the dose-dependent effect of administration of commercially available intravenous immunoglobulins (IVIG) on the survival of newborn rats experimentally infected with group B streptococci (GBS). The opsonic activity of various concentrations of IVIG in vitro was determined by examination of opsonophagocytosis of GBS by peritoneal macrophages and bacterial killing by blood neutrophils. The best survival was observed in newborn rats who received immunoglobulins at doses of 250, 500 and 1000 mg/kg of bodyweight. The survival of animals that received either 125 mg/kg or 2.5 g/kg of immunoglobulins was no better than that of animals who received no immunoglobulins. The maximal phagocytosis and bacterial killing were observed at in vitro immunoglobulin concentrations ranging from 32 to 250 mg/dL (these in vitro concentrations may correspond roughly to in vivo administration doses ranging from 150 to 1200 mg/kg). These doses are comparable to the doses of IVIG currently administered to neonates. However use of very high doses may be harmful to babies since the high concentration of non-specific immunoglobulins inhibited in vitro phagocytosis and bacterial killing by phagocytes.     

A Case of Colon Cancer Metastasizing to the Spleen

A case of colon cancer metastasizing to the spleen is reported.The patient was a 43-year-old man who was laparotomized underthe diagnosis of colon cancer. The tumor of the transverse colonshowed a small ulcer and polypoid projections. Poorly differentiatedadenocarcinoma was noted in the mucosa. Marked tumor metastasiswas found in the parenchyma of the spleen and the peripancreatic,portohepatic, mesenteric and periaortic lymph nodes. The literatureon the incidence and mechanism of metastasis to the spleen wasreviewed, and mtastasis to the spleen was found to be not infrequentat a late or advanced stage of cancer.     

A Case of Small Cell Lung Cancer Successfully Treated with VM26

A 79-year-old man was admitted to our hospital for a close examinationof an abnormal shadow on a routine chest roentgenogram. A largetumorous shadow in the right S¹ segment, and hilar and mediastinalnode swelling were observed. Transbronchial biopsy revealedthat the histologic type of the tumor was oat cell carcinoma.The clinical stage was considered to be limited disease. Becauseof his age, 79 years, he was treated with VM26 as a single agent.VM26 was administered by intravenous drip infusion of 60 mg/m²daily for five consecutive days every three to four weeks. Afterthe third course of treatment with VM26, he achieved partialresponse, and then radiation therapy to the primary site andthe hilar and mediastinal nodes was given at a total dose of6,000 rad. There have been few phase II studies of VM26 in patientswith small cell lung cancer (SCLC). Further phase II studiesshould be conducted for confirmation of the reproducibilityof the phase II study of VM26 in SCLC, and the efficacy of combinationchemotherapy including VM26 against SCLC should also be tested.