Urinary leukotriene E4 in Henoch–Schonlein purpura

BACKGROUND: Children with Henoch-Schonlein purpura (HSP) occasionally have allergic disease. We have previously shown that pranlukast hydrate was effective for purpura in HSP. Pranlukast hydrate is a leukotriene (LT) receptor antagonist; therefore, it is likely that LTs take part in the cause of HSP. Urinary leukotriene E4 (LTE4u) levels are a useful index of whole-body cysteinyl LT production in vivo. In this study, LTE4u was examined in children with HSP. OBJECTIVE: The purpose of this study was to examine the relation between the level of LTE4u and the cause of HSP. METHODS: Eighteen HSP children (six boys and 12 girls) and six healthy children were enrolled. RESULTS: LTE4u levels in patients with HSP were significantly higher (P< 0.05) at the onset than those in healthy children. Four weeks therapy with pranlukast hydrate lowers LTE4u levels in patients with HSP (P< 0.05). There were no differences in LTE4u between the group of HSP patients with purpura nephritis and the group of HSP patients without purpura nephritis. CONCLUSION: These results indicate that csyteinyl LTs may play a role in the pathophysiology of purpura in HSP.     

A quantitative approach to technetium-99m hexamethylpropylene amine oxime

A non-invasive, simple method for the quantitative evaluation of brain perfusion is presented using intravenous radionuclide angiography with technetium-99m hexamethylpropylene amine oxime (^99mTc-HMPAO). Graphical analysis was employed for the evaluation of the unidirectional influx constant (k _u of the tracer from the blood to the brain. The k _u values were standardized to provide objective and comparable values, brain perfusion indices (BPI), among studied subjects by setting the ratio of ROI_brain size to ROI_aorta size at 10. The wholebrain BPI values for the normal control subjects showed a significant negative correlation with advancing age (r = -0.632, P =0.0204, n =13). The mean of the wholebrain BPI of 7.0 (SD =1.4) in 20 patients with cerebrovascular disorders was significantly lower than that of 10.6 (SD =1.5) in 13 normal control subjects. The BPI measurements showed only minimal intra- and interobserver variability. Changes of the ratio of ROI_aorta size and ROIbmin size did not significantly influence the BPI values. Hemispherical BPI values in 19 subjects (n =38) showed highly significant correlations with the hemispherical mean cerebral blood flow values obtained from Xenon-133 single photon emission tomography (SPET) (r =0.926, P =0.0001 for the early picture method and r =0.932, P =0.0001 for the sequential picture method). This technique is easy to apply as an adjunct to SPET and may be helpful in the quantitative evaluation of brain perfusion in routine clinical studies. Offprint requests to: H. Matsuda     

A case of hepatocellular carcinoma with tuberculoma within tumor tissue

We made a diagnosis of hepatocellular carcinoma and performed partial resection of the liver in a 72 year-old woman. Granulomas were observed within hepatocellular carcinoma in the surgical specimen. Microscopic findings demonstrated the granulomas particularly within the tumor, and showed that they were composed of epithelioid cells with caseous necrosis. These tuberculomas compressed the tumor cells, and many lymphocytes had infiltrated the tumor around the tuberculomas. The cancer stage of the patient was early and her prognosis is good.     

Extraperitoneal anterolateral discectomy for lumbar disc herniation: indications, techniques, and time-related clinical results.

We analyzed 80 consecutive cases of lumbar disc herniation who underwent an extraperitoneal anterolateral discectomy according to clinical and radiologic parameters. The average follow-up period was 5 1/2 years (range, 1-10 years). The results of 71 patients (89%) were satisfactory through the mid- and long-term follow-up periods, although a very slight decrease in subjective/objective scores and ADL score was found. Satisfactory results were obtained for adolescent and younger male adults and in isolated central or centrolateral herniations with a broad base. From an analysis of the nine reoperated cases, we determined that the contraindications of this technique are a sequestrated or extruded nucleus pulposus and disc protrusion accompanied by posterior dislocation of a vertebral edge fragment. The relative indications include a small, hard posterolateral herniation located just beneath the nerve roots, double-level herniation, disc herniation accompanied by narrow spinal canal, and bulged disc in elder patients. The absolute indications for this surgery are a centrally or centrolaterally protruded disc with a relatively broad base of herniation at single-disc level that is not accompanied by spinal stenosis in adolescent and younger male adults.