Spontaneous rupture of the urinary bladder

A case of non-traumatic rupture of the urinary bladder is reported. The patient, a 52-year-old woman, was admitted to our clinic with the chief complaints of dysuria and gross hematuria after hemorrhoidectomy. Ultrasonography and CT scan showed a huge mass in Retzius' cavity. Then, rupture of the bladder was diagnosed through subsequent cystoscopy and cystography. During surgery, we recognized a large defect in the anterior wall of the urinary bladder associated with reddish-yellow fluid in the pelvic cavity. Histological findings showed no malignant change in the bladder. Various factors were suspected to be related to this spontaneous rupture of the urinary bladder.     

Maintenance hemodialysis poses few limitations for liver surgery

A hepatic mass was detected in two patients on regular hemodialysis for chronic renal disease. Hepatic resection was carried out with no untoward effects. We wish to emphasize that meticulous perioperative management of chronic renal failure has to be designed for such patients.     

A Case of Tardive Tourette-Like Syndrome

Abstract: We have had experience in treating tardive Tourette-like syndrome on a chronic schizophrenic patient. The patient was a 38-year-old woman. A diagnosis of schizophrenia was made in 1971 and she received repeated medications for 17 years. In 1989, she began to show vocal tic with coprolalia and motor tic. The medications were haloperidol 18 mg, zotepine 200 mg, levomepromseine 100 mg, biperiden 3 mg and nitrazepam 10 mg at the beginning of Tourette-like syndrome. We have tried to change the medications but this tardive Tourette-like syndrome continued to hang on. However, the symptoms gradually improved after a change in drugs; cessation of biperiden 3 mg and the administration of clonazepam 3 mg. The present case suggested that tardive Tourette-like syndrome might be a subtype of neuroleptic-associated tardive syndromes which might be treated with clonazepam.     

Successful Endoscopic Treatment of Diffuse Antral Vascular Ectasia and Early Gastric Carcinoma in an Aged Patient

Diffuse antral vascular ectasia and a lla type early gastric cancer were detected in an 83-year-old male patient through an endoscopy during treatment for iron deficiency anemia. Monopolar electrocoagulation was effective for eradication of red spots which represented ectatic vessels. Five sessions of the therapy resulted in the ablation of almost all of the vascular lesions, negative fecal occult blood tests and improvement of his anemia. The lla lesion was endoscopically resected from the posterior wall of the upper body. Histologic examination demonstrated well differentiated adenocarcinoma confined to the mucosal layer. Both the vascular ectasia and carcinoma did not show any sign of recurrence after a year and a half.     

Effects of 3 months of non-weight-bearing cycle ergometric exercise on bone metabolism

We evaluated the effect of non-weight-bearing exercise on bone metabolism by measuring serum levels of biochemical markers, N-terminal osteocalcin (OC), and intact OC. N-terminal assay using the radioimmunoassay (RIA) method is considered to be a marker of bone turnover. Intact OC was measured as a marker of bone formation by the sandwich enzyme-linked immunosorbent assay (ELISA) method. As is commonly known, the cycle ergometer is a very popular and useful tool for aerobic exercise used world wide to improve health. In this study, we evaluated the effect of such common exercise on N-terminal OC and intact OC using a cycle ergometer. N-terminal OC was not significantly changed after 30min of aerobic training with a cycle ergometer three times a week for 3 months, whereas intact OC decreased significantly. No changes in bone mineral density of weight-bearing or non-weight-bearing bones were found. These results suggest that the type and duration of exercise using the current training method were insufficient to produce a favorable effect on bone. The current training method consisted of aerobic, non-weight-bearing exercise alone using a cycle ergometer. It is unknown whether the non-weight-bearing form of exercise was responsible for our results, or whether the aerobic exercise itself was insufficient. The 3-month period may have been insufficient to stimulate osteogenesis, and it is possible that an exercise period of this duration may instead result in a tendency to suppress bone formation. At any rate, we believe it is significant that we were able to demonstrate, on the basis of changes in bone metabolism markers and bone mineral density, that the nature of this exercise was insufficient to stimulate osteogenesis.     

Immunoselection of human lymphocytes producing xenoreactive natural antibodies against Galocl,3Gal terminal residues

Abstract: In the pig-to-human xenograft combination, human xenoreactive natural antibodies (XNA) bind to carbohydrate moieties, especially those with Galα1,3Gal terminal residues, expressed on the surface of most cells. The aim of this study was to select the cells that produce XNA by functionally characterizing a subset of cells for future studies on immunosuppression of XNA formation. We especially addressed the question whether XNA could be produced by CD5+ B lymphocytes, a subset of cells producing antibodies of high connectivity and polyreactivity, possibly involved in autoimmune processes. For that purpose we used porcine thyroglobulin (PTg), which expresses several Galα,3Gal terminal residues, for the immunoselection of XNA-producing cells. On FACS analysis, biotinylated PTg appeared to react with 5% of the B lymphocytes but the proportion of CD5+ B lymphocytes was not enriched in the PTg-reactive population. Similarly, magnetic beads coated with PTg were used to sort lymphocytes with Ig receptors recognizing PTg. Two and one-half percent of cells reacted, mainly B lymphocytes (89%), but they were not enriched for CD5+ B lymphocytes. When PTg-reactive lymphocytes were cultivated in presence of irradiated T cells and stimulated with PWM, the synthesis of Galα1,3Gal reactive antibodies, mainly of the IgG class, was demonstrated. The results of this study suggest that a high percentage of B lymphocytes react with Galα1,3Gal terminal residues. Such XNA-producing cells are not particularly common in the CD5+ subset.