PELIOSIS HEPATIS: IMPROVEMENT OF ESOPHAGEAL VARICES AFTER THE SURGICAL TREATMENT OF PLACENTAL SITE TROPHOBLASTIC TUMOR OF THE UTERUS

We report a case of peliosis hepatis associated with placental site trophoblastic tumor (PSTT) of the uterus. A 46‐year‐old woman was admitted to our hospital with complaints of leg edema, pleural effusion and ascites, complicated with esophageal varices. Peritoneoscopy did not show any evidence of liver cirrhosis and liver biopsy revealed peliosis hepatis. Later, uterine tumor was detected and, after a hysterectomy, peliosis hepatis and esophageal varices were dramatically improved. We suggest that the uterine tumor caused peliosis hepatis with fibrosis and that portal hypertension developed as a consequence of these lesions. The present case is of interest because esophageal varices were improved without ordinary treatment.     

Evaluation of proximal tubular function in preterm infants by urinary α1-microglobulin

α₁-Microglobulin is a low molecular weight protein that is relatively stable in urine of low pH. There have been few reports on urinary α₁-microglobulin (U-A₁M) excretion in preterm infants. This study was designed to establish the ranges for U-A₁M in clinically stable preterm infants and to investigate changes observed in sick preterm infants. We measured U-A₁M and urinary β₂-microglobulin (U-B₂M) levels at 1, 4, 7, 14, 28 and 90 days after birth in stable preterm infants (Group 1) and sick preterm infants who were depressed at birth and required immediate resuscitation (Group 2). In Group 1 infants, both parameters were high during the first 28 days and appeared to decline thereafter. U-A₁M in Group 2 infants was only significantly increased compared with Group 1 on day 1, as was U-B₂M. On each day of the study, U-A₁M had significant positive correlations with U-B₂M for all the infants studied. The changes of the two parameters observed in Group 1 probably reflect postnatal evolution of proximal tubular function in stable preterm infants. A comparison of groups 1 and 2 shows a high prevalence of acute tubular injury at birth in sick infants and also suggests that U-A₁M as well as U-B₂M may be a sensitive index for detecting acute tubular damage and for following its course in preterm infants.     

Perinatal medical support in the area surrounding the Hanshin-Awaji earthquake

After natural disaster, perinatal medical care must usually be provided from outside the disaster area, because most of the medical efforts inside the area focus on patients without special needs. This study reviews the emergency perinatal medical response after the great Hanshin-Awaji earthquake. In the present study, we summarize records of telephone calls and reports from the Neonatal Mutual Cooperative System (NMCS). The day of the earthquake, very little information was available to or from the disaster area. The day after the earthquake, Osaka City General Hospital (OCGH) and Osaka Medical Center and Research Institute for Maternal and Child Health were established as key facilities, and OCGH served as a center through which information passed to and from the disaster area. Most telephone calls to OCGH were placed on the second day after the earthquake by pregnant women concerned about their deliveries. Many high-risk pregnancies and newborn infants were transferred out of the disaster area over the next month. This analysis shows that although the emergency response was very rapid in this instance, the operation may be significantly improved in disasters of this magnitude: (i) if a communication mechanism able to serve a large volume is established; (ii) if helicopter transport was easily available; and (iii) if key facilities to handle communications were previously established so as to be available immediately.     

Lymphangioma of the kidney

Lymphangiomas are rare benign tumors that are congenital malformations of the lymphatic system. Most cases present in children as a soft, cystic mass in the neck and the axilla. Primary renal lymphangioma is exceedingly rare, with only 35 cases reported so far. We report a case of primary lymphangioma arising from the kidney. A 59-year-old man was referred for evaluation of a right renal mass found in an abdominal ultrasonography during a health checkup. Abdominal ultrasonography and computed tomography (CT) revealed a 3.2 x 2.9 cm multiloculated cystic mass in the upper pole of the right kidney. We could not deny malignant disease such as cystic renal cell carcinoma with any diagnostic modalities. The patient was brought to surgery. During the surgical procedure, the tumor was suspected to be lymphangioma of the kidney as a result of a frozen- section histopathological evaluation. Therefore enucleation of the tumor was performed. Pathological evaluation of the specimen revealed lymphangioma arising from the kidney. The patient is free of disease after a 3-month follow-up period.     

Situations occasioning cocaine use and cocaine abstinence strategies

We interviewed 265 cocaine-experienced methadone patients about situations that occasioned their cocaine use and strategies they used to avoid cocaine use. Subjects identified an average of 15 situations that occasioned cocaine use. The three most frequently identified were having the drug present (86% of subjects), being offered the drag (85%) and having money available (83%). Subjects reporting fewer situations also reported longer periods of lifetime abstinence (p< 0.01). A principal components analysis extracted 10 groups of situations that were most frequently identified in combination. Subjects identified a median of seven strategies for avoiding cocaine use; however, there was large inter-subject variability. This variance was not accounted for by demographic variables, employment status or treatment experience. The three strategies identified most frequently were avoiding people and places (81%), thinking about what they could lose (76%) and leaving the situation (66%). The total number and type (reactive vs. proactive) of strategies identified by subjects had no relationship to cocaine abstinence, although four specific strategies (thinking about what could be lost, leaving the situation, moving to a new area and using a different drug) were positively correlated with cocaine abstinence. We discuss implications of these results for clinical practice.     

An Unusual Case of Portasystemic Encephalopathy Caused by Splenic Vein Occlusion Following Gastrectomy

A patient with recurrent episodes of consciousness disturbance following partial gastrectomy is presented. Angiographic examination revealed a great portasystemic shunt, which probably developed following the postoperative splenic vein thrombosis. This is suspected a rare cause of the condition. In chronic liver disease, recurrent encephalopathy which is caused by portasystemic shunt is well known as one of the most frequent complications. It is very uncommon in adults, however, when the liver is not concerned in the shunt formation. In the present paper the authors report an unusual case of recurrent consciousness confusion which is due to the great portasystemic shunt probably caused by postgastrectomy splenic vein thrombosis.     

An Enzyme- and Immunohistochemical Study of Malignant Lymphomas

Thirty-three cases of malignant lymphoma were studied enzyme-histochemicallyin relation to their immunologically determined surface markersand tissue intracellular immunoglobulins by the peroxidase-antiperoxidasemethod. There were 18 B-cell derived, 11 T-cell derived andone nonT-nonB cell lymphomas and three cases of Hodgkin's disease.Two cases of infectious mononucleosis were also studied. Adenosine triphosphatase (ATPase) activity was found in sixof the B-cell lymphomas. However, two of the T-cell lymphomasalso showed ATPase activity. One of seven follicular lymphomasshowed both ATPase and alkaline phosphatase activities. Acidphosphatase activity was seen in three of the T-cell lymphomas,whereas it was also present in one of the six B-diffuse largecell type lymphomas and one B-diffuse mixed type lymphoma. These results, in addition to other enzyme activities, indicatethat enzyme histochemical activity is not sufficient for identifyingthe T- or B-cell nature of the neoplastic cells. They seem ratherto indicate the functional status of neoplastic cells.     

Intracellular Transcobalamins in Various Cultured Cell Lines Established from Hematological Malignancies

Intracellular transcobalamins (TCs) in 17 cultured cells establishedfrom hematological malignancies were measured to solve the cellularorigin of TCs. The cultured cell lines used in this study areas follows: myeloid cell lines K-562, HL-60, NALM-1; T-celllines P12/lchikawa, MOLT-4B, CCRF-CEM, RPMI-8402, MT-1; B-celllines P3HR-1, Daudi, BALL-1; nonT, nonB cell lines NALM-16,KOPN-1, Reh, P30/Ohkubo, NALL-1; and, as control cells, P13/Koyamaderived from normal B-cells, normal human lymphocytes and granulocytes.The homogenized cytoplasmic fraction was incubated with ⁵⁷CoB₁₂ and subjected to DE₅₂ cellulose column chromatography andpolyacryla mide gel electrophoresis (PAGE) to separate TC₁₁from R-binders. In myeloid cell lines established from blasticcrises of chronic myeloid leukemia, K-562 had the highest TC₁₁/R-bindersratio, while NALM-1 had the lowest, suggesting that the myeloidand lymphoid crises of chronic myeloid leukemia may have differentTC₁₁/R-binders ratio. T and B cell lines showed no differencein intracellular TC levels. NonT, nonB cell lines had the lowestlevel of intracellular TC. ^*Present address: Department of Internal Medicine, JikeikaiUniversity Auto Hospital, Tokyo.     

Combined assessment of chronic kidney disease and subclinical peripheral artery disease used to predict future cardiac events

Background: Both the presence of peripheral arterial disease and chronic kidney disease has been reported to be independent risk factors associating with poor prognosis. However, the impact of combination of peripheral arterial disease and chronic kidney disease remains unknown. Methods: The long‐term outcome in 715 consecutive patients who had undergone coronary angiogram for the evaluation of chest pain was analyzed. Patients on haemodialysis were excluded from this analysis. Cohort patients were divided into four groups according to the Ankle Brachial Index (ABI <0.9) and glomerular filtration rate (GFR <60 mL/min per m²): group A (n= 498; ABI >0.9, GFR >60); B (n = 65, ABI <0.9, GFR >60); C (n = 99; ABI >0.9, GFR <60); and D (n = 53; ABI <0.9, GFR <60). The mean follow‐up period was 620 ± 270 days and evaluated the major cardiac adverse events included survival, stroke, acute coronary syndrome and heart failure. Results: The mean follow‐up period was 620 ± 270 days. Total long‐term event was present in 89 patients (groups A–D were 9.4%, 18.5%, 15.2% and 28.3%, respectively). Long‐term event rate was 28.3% for patients with the presence of peripheral arterial disease and chronic kidney disease, compared to 9.4% for those without peripheral arterial disease and chronic kidney disease (P < 0.0001). Kaplan–Meier event‐free survival curves also showed that the combination of peripheral arterial disease and chronic kidney disease predicted long‐term event rate. Conclusion: The combination of chronic kidney disease and ABI of less than 0.9 undergoing coronary angiogram is strongly associated with long‐term event rate.