Adenosquamous Cell Carcinoma of the Colon with Severe Hypercalcemia: --Report of Two Cases--

Two patients with adenosquamous cell carcinoma of the colon,who presented severe hypercalcemia, are reported. Adenosquamouscell carcinoma of the colon is relatively rare, and there wereonly two cases among 1,053 patients who were hospitalized withmalignancy in the large intestine at the National Cancer CenterHospital during the past 18 years. Both of these cases presentedlethal hypercalcemia in the absence of osseous metastasis, andthere were no other patients who had malignant tumors of thelarge intestine and presented hypercalcemia. These observationssuggest that there is a close relationship between the squamouscell component and the occurrence of hypercalcemia, as is observedin the case of lung cancer. Radioimmunoactive parathyroid hormonewas undetectable in the plasma and the tumor tissue in thesetwo cases.     

Trends in neonatal exchange transfusions at Yodogawa Christian Hospital

A review was conducted to determine the trends in exchange transfusion (ET) of newborn infants at the Yodogawa Christian Hospital during the past 18 years. At that hospital in 1957, the first ET was performed on a term infant with severe hemolytic jaundice caused by rhesus factor (Rh) incompatibility. By 1989, ET had been performed in more than 1400 newborn infants. These cases of newborns who had had ET were retrospectively reviewed, with a focus on every 3 year period from 1974 to 1992. The total number of infants requiring ET noticeably decreased from 68 cases (14.0% of total admissions) in 1974 to 19 cases (6.1% of total admissions) in 1992. (X², P < 0.001) There were three major significant changes in ET during those years. The first was a change in the subjects for ET. The incidence of ET for term infants showed a marked decrease, while the incidence of ET for preterm infants, especially for very low birthweight (VLBW) infants (< 1500 g), noticeably increased. The second was a change in indications for ET. There was a marked decrease in the need for ET as a result of hyperbilirubinemia, while the incidence of ET because of other etiologies, such as septicemia and/or disseminated intravascular coagulopathy, noticeably increased. The third was a change in the technical methods of ET. Now at the Yodogawa Christian Hospital, 100% of the infants are given ET with an automated peripheral two-site method, instead of the Diamond method. Although ET might still be a useful treatment for severe hyperbilirubinemia and other acute problems, the total number of ET noticeably decreased in accord with a decrease in the number of severe hyperbilirubinemia in term newborns. On the other hand, the incidence of ET in preterm infants increased relatively, accompanied by an increase in the survival of VLBW infants. The automated two-site method is the preferred technique for ET at the Yodogawa Christian Hospital, rather than the Diamond method. Further changes in ET might occur in accord with new alternative measures in future.     

Treatment of atelectasis of upper lung lobes. Selective bronchial suctioning with J-shaped catheter tip and guide mark

We developed a technique for blind bronchial suction using a curved-tip catheter with a guide mark, for the treatment of atelectasis of the lower and middle lobes of the lung. Suction of the upper lobe bronchi could not be performed because of the combination of the peculiar anatomy of the upper lobe bronchi with catheter design. We treated successfully two cases of atelectasis of the right upper lobes using a Rusch Metras bronchography catheter with a guide mark which is not readily available. Therefore we devised a J-shape tipped catheter with a guide mark. We have successfully treated 13 episodes of atelectasis of the right upper lobe in 10 patients and one episode in the left upper lobe in one patient with this new catheter.     

Two Cases of Carcinoid Tumor of the Stomach which Responded to Oral Coadministration of Tegafur and Uracil

Tegafur, 1-(2-tetrahydrofuryl)-5-fluorouracil, was administeredin combination with uracil to two patients with carcinoid tumorof the stomach and the effect of the drug was evaluated. The first patient was a 67-yr-old woman. She was admitted becauseof an upper abdominal tumor. Exploratory laparotomy revealeda gastric tumor and an additional huge tumor with liver metastasisand peritoneal dissemination. Histological examination of biopsyspecimens from the gastric tumor and metastatic lesions revealedcarcinoid tumor. Tegafur and uracil were coad-ministered postoperatively.During three months of treatment the gastric tumor improvedendoscopically and the large abdominal tumor decreased from10x10 cm to 4x4 cm. The second patient was a 55-yr-old man. He was admitted becauseof severe diarrhea. Biopsy from a gastric lesion and metastaticskin lesions revealed carcinoid tumor. After coadministrationof tegafur and uracil and mitomycin C, the metastatic skin lesionsbecame smaller and some of the lesions disappeared. The liveralso decreased in size. These two cases suggest the possibility that coadministrationof tegafur and uracil may be effective for carcinoid tumor ofthe stomach.     

Colo-Rectal Carcinoma in Young Adults

A study of 25 young adults under the age of 29 treated by surgeryfor carcinoma of the large intestine was made to compare with693 older-age group of patients. The incidence of adenocarcinomaof the large intestine in the first thirty years of life was3.5%. At the time of surgery, 64% of the patients had metastaticdisease, and the five-year survival rate for 19 curatively treatedcases was 37%. The coincidental second and third carcinoma ofthe large intestine and the association of familial polyposiscoli were significantly frequent in the younger age group. Onthe other hand, the association of ulcerative colitis or Crohn'sdisease could not be found in either of the group. The highincidence of mucin-producing tumors in the younger group wasalso confirmed. The Cumulative No Evidence of Disease (NED)rate after the curative surgery was lowest among patients ofthe first-three-decade age group and showed; stepwise high valueas the decade of age increased.     

Effects of halothane on membrane ionic currents in guinea pig atrial and ventricular myocytes

We studied the effects of halothane on membrane potentials and ionic currents in single guinea pig atrial and ventricular cells prepared by an enzymatic dispersion procedure. In both atrial and ventricular cells, action potential overshoot and its plateau phase were significantly decreased by halothane (2%) without change in resting potential. However, the duration of the ventricular action potential measured at 90% repolarization was markedly shortened by halothane (2%) (to 60% of control), whereas that of the atrial action potential did not change significantly. Corresponding voltage clamp experiments demonstrated that in atrial cells halothane (2%) significantly depresses the time- and voltage-dependent outward K+ current (IK) (to 46% of control); and that in ventricular cells IK is then nearly absent. In both atrial and ventricular cells halothane had no effect on the inwardly rectifying K+ current (IK1). On the other hand, halothane (2%) decreased the slow inward Ca2+ current (ICa) in both atrial and ventricular cells (to 36% and 29% of control, respectively). The results suggest that the shortened action potential in ventricular cells by halothane may well be responsible for the decrease of the plateau phase resulting from the depression of ICa; and that in atrial cells the depression of IK and ICa by halothane had no significant effect on the duration of action potential.     

Hydrolysis of various types of ester substrates with linear,cyclic and polymeric peptides containing His,Ser and Asp residues

Catalytic activities of linear, cyclic and polymeric peptides having the sequences of -Asp-ßAla-Gly-His-ßAla-Gly-(nonapeptide series) and -Asp-eAhx-Ser-eAhx-His-eAhx- (hexapeptide series) in the hydrolysis of various types of ester substrates were compared with one another and with that of poly (-His-ßAla-Gly) (Poly-3) which has no Ser or Asp residues. Hydrolytic activity of the hexapeptide series, the cyclic form in particular, was larger than that of the nonapeptide series in many cases such as in the hydrolysis of N-protected amino acid p-nitrophenyl esters (Z-Gly-ONp, Boc-Ala-ONp, Z- (l and d ) -Leu-ONp, Boc- (l and ) -Phe-ONp) and anionic 3-nitro-4-acetoxybenzoic acid ( NABA ). The activities of the polymeric peptides were generally smaller than those of the linear or cyclic peptides. None of the peptides showed the remarkable activity to the hydrophobic substrate with long chain, p-nitrophenyl laurate ( PNPL ), and they were almost inactive to bulky p-nitrophenyl trimethylacetate ( PNPTMA ) and cationic 3-acetoxy-N-trimethylanilinium iodide ( ANTI ). Enantiomer-selectivity in the hydrolysis of N-protected amino acid p-nitrophenyl esters and solvent isotope effect in the hydrolysis of p-nitrophenyl acetate ( PNPA ) are also reported.     

Clinical features of testicular tumors in children

AIM: Testicular tumors are not common pediatric solid tumors, especially in Asian children. There have been few reviews of cases in Japan to date. We present the clinical features of 14 pediatric testicular tumor patients. METHODS: Clinical features of 14 testicular tumor patients, such as chief complaints, age at diagnosis, pathology, stages, treatments and prognosis, were examined from medical records. Two patients had their semen tested at adolescence. RESULTS: Of the 14 prepubescent patients, 12 (85.7%) patients were diagnosed before 3 years of age. Ten cases (71.4%) were diagnosed as yolk sac tumors, three (21.4%) as mature teratomas and one case as an epidermoid cyst. Nine cases (90.0%) among the 10 cases of yolk sac tumor were diagnosed as stage I and one case was stage IV. One stage I yolk sac tumor patient developed lung metastasis later. Eventually, two yolk sac tumor patients died, despite chemotherapy. While all the cases with a diagnosis before 2 years of age survived, 67% (2/3) of cases with a diagnosis after the age of 2 died of tumors. Semen analysis in two patients showed normospermia. CONCLUSION: In the present study, the most common testicular tumors were yolk sac tumors and the patients diagnosed before 2 years of age showed favorable results. Age could be a relapse risk factor in yolk sac tumors. Guidelines for handling testicular tumors in children is not yet well established in Japan. An organized system seems necessary to gather and accumulate the results of the cases in Japan in order to develop better guidelines for treatment.     

Local Recurrence after Sphincter-Saving Procedures for Carcinoma of the Rectum--An Analysis of 141 Cases--

During the past 18 years, 141 patients with rectal carcinomaunderwent curative sphincter-saving procedures. Local recurrencesoccurred in 17 patients, a recurrence rate of 12%. No significantcorrelation between the recurrence rate and the site of tumoror nodal involvement was found. Laparotomies were performedin 14 of the 17 patients with local recurrence. Thirteen patientsunderwent abdominoperineal excision. In five of them, the recurrentgrowths were completely resected, and they were thought to havedeveloped at the previously established suture line, while inthe remaining eight cases the operation was considered palliative.As the result of pathological study of these resected specimens,it is possible to draw the following conclusions:

1. The length of the distal margin of the normal bowel should bemore than 4 cm in locally advanced cases.
2. In patients whosesecond operation was not curative the recurrencesdid not developin the rectal stump or in the levator muscle,but in the pelvicwall.
3. Local recurrence after sphincter-saving procedures couldbeeffectively avoided by adequate clearance of the pararectalsoft tissues which could contain viable cancer cells, includingthe lymphatics and vessels as well as the lymph nodes.
4. Aftera sphincter-saving operation, the patient must be examinedundera strict follow-up regimen, because curative resectionof localrecurrent tumors by abdominoperineal excision willbe made possibleby earlier detection of the recurrence.

     

Quantitative diffusion tensor tractography of the motor and sensory tract in children with cerebral palsy

Aim The aim of this study was to compare the findings of quantitative diffusion tensor tractography of the motor and sensory tracts in children with cerebral palsy (CP) and typically developed comparison individuals, and also to evaluate the correlation with gross motor function. Method Thirty‐four children with CP (mean age 2y 2.mo, SD 2y 0mo; 19 with spastic diplegia, eight with hemiplegia, six with spastic quadriplegia, and one with spastic triplegia) and 21 healthy comparison children (mean 2y 1.68mo, SD 2y 8.64mo) were evaluated. The distribution of Gross Motor Function Classification System (GMFCS) levels in the CP group was as follows: level I, 7; level II, 14; level III, 5; level IV, 3; and level V, 5. The following three diffusion tensor imaging (DTI) parameters including tractography were evaluated for each tract (corticospinal tract [CST] and posterior thalamic radiation [PTR]): number of fibres, tract‐based fractional anisotropy, and region of interest (ROI)‐based fractional anisotropy. We compared each value between the two groups, and correlated each value with the GMFCS level. Results The number of fibres and ROI‐based fractional anisotropy values of both tracts were significantly lower in children with CP than in the comparison group (p<0.05–0.001). Additionally, there was significant negative correlation between GMFCS level and motor–sensory parameters (p<0.001–0.05). Interpretation DTI parameters of the CST and PTR in children with CP were significantly lower than in comparison children. In addition, these parameters were significantly correlated with GMFCS level.