Testicular torsion: Usefulness of contrast-enhanced power Doppler sonography

A 13-year-old-boy with suspected left testicular torsion was referred to our institute. During preparation, a significant decrease of signals on the left testis was found, however, slight blood flow was detected by the ultrasound examination enhanced by Levovist. As a result of the examination we left the testis intact, although the color of the testicular parenchyma remained black. One year after the surgery, an ultrasound examination was done again and good vascurality was observed.     

Early onset of cecal perforation in neonatal,recto-sigmoid type Hirschsprung's disease

Hirschsprung's disease has been considered to cause intestinal perforation in rare cases. Even if a perforation occurs, the majority of cases are associated with the long-segment or total colonic type. Our case developed the perforation in the neonatal period in spite of being of the recto-sigmoidal type, and it affected the cecum. We do not have a good explanation for this condition. However, the pathological examination of the specimens of the perforated cecum revealed some necrosis (ulceration, subcutaneous hemorrhage, congestion and severe edema) which was considered to be caused by ischemia, secondary to a localized vascular accident in the wall of the distended intestine.     

Hepatic HCV-RNA as a predictor of outcome after interferon therapy in patients with chronic hepatitis C

Measurement of serum HCV-RNA is a useful index for evaluating the antiviral effect of interferon therapy in chronic hepatitis C. In the present study, we investigated whether the detection of hepatic HCV-RNA after interferon treatment, using a polymerase chain reaction assay, predicted long-term response to therapy in patients with chronic hepatitis C. Thirty-three patients underwent liver biopsies before and after interferon therapy. Histology and clinical courses were compared after treatment. Before therapy, serum and hepatic HCV-RNA was detected in specimens from 32 (97%) and 33 (100%) patients, respectively. Serum HCV-RNA became undetectable in samples from 22 (67%) patients; however, in 10 of these patients (45%), serum HCV-RNA levels relapsed after therapy. Hepatic HCV-RNA became undetectable in 14 patients after therapy and the serum aminotransferase concentration remained within normal limits during and following (24–92 weeks) therapy in 12 of these patients (86%). All 11 patients with detectable hepatic HCV-RNA also had serum HCV-RNA and elevated aminotransferase concentrations refractory to therapy. The absence of hepatic HCV-RNA at the end of interferon treatment thus predicted a long-term complete response to therapy with a sensitivity of 100%, a specificity of 90% and an accuracy of 94%. We conclude that hepatic rather than serum HCV-RNA is a more useful index for the prediction of the long-term efficacy of interferon therapy.     

雌激素受体基因多态性与儿童孤独症临床表型特征的关联研究

【目的】 探讨雌激素受体(estrogen receptor,ER)基因多态性与儿童孤独症临床表型特征的关系。 【方法】 应用TaqMan荧光探针Real-Time PCR的分析方法对127名孤独症患儿进行ERα的单核苷酸多态性片断rs11155819和ERβ的单核苷酸多态性片断rs1152582的基因型测定。用儿童孤独症评定量表(Children Autism Rating Scale,CARS)评价孤独症患儿临床表型特征。 【结果】 孤独症病情严重程度在rs11155819和rs1152582的不同基因型之间的差异无统计学意义(P>0.05)。rs11155819基因型为C/T、T/T的孤独症儿童在语言交流项得分的差异有统计学意义(P=0.048)。rs1152582基因型为C/C、G/G的孤独症儿童在非言语交流项、活动水平项得分的差异有统计学意义(P=0.035;P=0.030)。 【结论】 rs11155819基因型中,携带T/T的患儿比携带C/T的患儿有更明显的语言交流障碍。rs1152582基因型中,携带C/C的患儿比携带G/G的患儿有更明显的非言语交流障碍和活动异常。     

Drug Metabolism: Activation of 11 β-Hydroxysteroid Dehydrogenase by Dehydroepiandrosterone Sulphate as an Anti-hypertensive Agent in Spontaneously Hypertensive Rats

The anti-hypertensive properties of dehydroepiandrosterone sulphate (DHEAS) have been investigated by studying its effects on blood pressure, on serum concentrations of corticosterone and dehydrocorticosterone, and on 11 β-hydroxysteroid dehydrogenase (11 β-HSD) activity in spontaneously hypertensive rats (SHR). SHR were given intraperitoneal injections of DHEAS (10 mg day^?1 for 70 days) from six to 16 weeks of age. The blood pressure–time curve was significantly (P<0.05) suppressed immediately after administration of DHEAS. There was no difference between the heart rates of control and DHEAS groups. Serum concentrations of corticosterone and dehydrocorticosterone in the DHEAS group were significantly (P < 0.05) lower than those of the control group. The dehydrocorticosterone/corticosterone concentration ratio was, however, significantly (P < 0.05) higher in the DHEAS group, suggesting that treatment with DHEAS enhanced the overall interconversion of corticosterone to dehydrocorticosterone. The activity of 11 β-HSD in specific organs of the DHEAS group was affected, characteristic changes being increases in the kidney (14–58%), decreases in the liver (11–27%) and no change in the testis. Direct addition of DHEAS to 11 β-HSD preparations from the kidneys of control SHR had the same effect as that observed in the in-vivo experiments. The fall in serum corticosterone in the DHEAS group is considered to be related, at least partly, to increased activity of kidney 11 β-HSD. The inverse correlation of kidney 11 β-HSD activity with serum corticosterone and blood pressure (—r = 0.628, P < 0.01, and —r = 0.478, P < 0.05, respectively) suggest that DHEAS delayed the development of hypertension in SHR by selective promotion of kidney 11 β-HSD activity which in turn resulted in lower serum concentrations of corticosterone and its minimal aldosterone-like activity.     

Clinical study of complicated urinary tract infection using ''The UTI Criteria (Draft Fourth Edition)'': Measurement methods for pyuria

OBJECTIVE: To evaluate the influences the change of the measurement method of pyuria from conventional centrifuged sediment to microchamber uncentrifuged urine for the results of evaluation of antimicrobial agents in clinical study against complicated urinary tract infections. From the viewpoint of international harmonization of judgement criteria, the recent method for counting white blood cells (WBC) in urine has changed from using uncentrifuged urine to using a microchamber in all countries. METHODS: Targeted diseases were non-catheterized complicated urinary tract infection, and cefcapene pivoxil hydrochloride or levofloxacin were used as antimicrobial drug. Pyuria was examined using the counting chamber method, a quantitative method using uncentrifuged urine with a microchamber, and the sedimentation method. RESULTS: Overall clinical efficacy in early evaluation by the two methods in measuring pyuria was evaluated as different in eight patients (7.3%). It was rated excellent in 63 (52.9%), moderate in 32 patients (26.9%) and poor in 24 (20.2%) with an efficacy rate of 79.8% using the counting chamber method, and excellent in 68 (57.1%), moderate in 27 (22.7%) and poor in 24 (20.2%) with an efficacy rate of 79.8% using the conventional sedimentation method CONCLUSION: No significant difference was seen between the two methods of WBC count in urine.     

High dose chemotherapy including paclitaxel (T-ICE) combined with peripheral blood stem cell transplantation for male germ cell tumor. Preliminary report

AIM: To evaluate the feasibility and usefulness of high dose chemotherapy including paclitaxel (T-ICE) combined with peripheral blood stem cell transplantation (PBSCT) for male germ cell tumor. METHODS: Five male patients with advanced germ cell tumor underwent 1-6 courses of high dose chemotherapy including paclitaxel (T-ICE; 175 mg/m2 of paclitaxel, 1250 mg/m2 of carboplatin, 1500 mg/m2 of etoposide and 7.5 g/m2 of ifosfamide) with PBSCT after 2-3 courses of induction chemotherapy (PEB or VIP). RESULTS: In all patients, serum marker levels decreased to within the normal range by T-ICE. Two patients underwent resection of residual tumor. In one patient, viable cancer cells were detected in resected lymph node tissue and adjuvant chemotherapy was then performed. Although the follow-up period was short (7-15.5 months), four of the five patients (80%) showed no evidence of recurrent disease. No significant differences in side-effects were noted between T-ICE and conventional high dose ICE, which was previously performed in 39 patients at the Division of Urology, Kobe University Graduate School of Medicine, Japan. CONCLUSIONS: High dose chemotherapy, including T-ICE, combined with PBSCT showed an almost identical degree of side-effects as seen in previous high dose chemotherapy without paclitaxel. Although 80% of the patients showed no evidence of disease so far, the efficacy of T-ICE should be evaluated with more patients and longer follow up.     

STUDY OF AXONAL DYSTROPHY. I. PATHOLOGY OF THE NEUROPIL OF THE GRACILE AND THE CUNEATE NUCLEI IN AGEING AND OLD RATS: A STEREOLOGICAL STUDY

The changes with age in the neuropil of the gracile and the cuneate nuclei of rats were studied using stereological techniques, in relation to the occurrence of axonal dystrophy. The following were found: (1) significant difference in the volume fraction of presynaptic boutons between the gracile and the cuneate nuclei throughout the whole life span (17% and 13% respectively at 100 days of age); (2) progressive decrease in the volume fraction (34% decrease in the gracile nucleus between 100 and 800 days of age) and in the numerical density of presynaptic boutons, the decline being evident as soon as the animals reached maturity and before axonal dystrophy became manifest; (3) significant differences in the volume fractions of dendrites and of nerve cell bodies between the two nuclei throughout the whole life span of the animals, both being greater in the cuneate than in the gracile nucleus; an agerelated decrease in the volume fraction of dendrites was also suspected in the gracile nucleus; (4) progressive increase in the volume fraction of fibrous astrocytic processes (from 3% at 100 days to 10.5% at 800 days in the gracile nucleus); (5) the above described age-related changes of presynaptic boutons and fibrous astrocytic processes were significant only in the gracile nucleus, not in the cuneate. The loss of boutons in ageing gracile nuclei was partially reflected in the appearance of degenerating nerve fibres in ageing gracile tract in the rostral cervical cord. Involutional loss of boutons and dystrophic formation of spheroids both appear and progress closely related in time and space. It was suggested that this set of changes can be understood as one integrated whole in which axonal dystrophy may represent only one side of the coin. The question of the causal mechanism of axonal dystrophy still remains unanswered.     

Cancer of the Pancreas: The Accuracy of Clinical Diagnosis and Its Time Trends in Japan During a 15-Year Period (1958-1972)

Autopsy data for all of Japan from 1958 through 1972 were analyzedto determine the accuracy of clinical diagnosis of pancreaticcancer and its time trends. The results showed that 53.9% of4,819 cases of pancreatic carcinoma proved at autopsy has beenunderdiagnosed clinically (underdiagnosis rate), whereas 31.7%of 3,254 cases with a clinical diagnosis or suspicion of thecancer were found by autopsy to have been overdiagnosed (overdiagnosisrate) during the period examined. The time trends in underdiagnosisand overdiagnosis rates showed a 7.8% and 4.9% improvement,respectively. The degree of diagnostic improvement observeddid not appear to be great enough to account for a substantialpart of the reported increase in pancreatic cancer mortalityin this country.