Computed tomography and 131I-MIBG scintigraphy in the diagnosis of pheochromocytoma

In order to evaluate the usefulness of computed tomography (CT) and 131I meta-iodobenzylguanidine (131I-MIBG) scintigraphy for the localization of pheochromocytoma, a prospective study was undertaken in 23 patients with possible pheochromocytoma. Seventeen tumors were identified in 13 patients. Two tumors were extra-adrenal. CT was superior for locating tumors in the adrenal glands while 131I-MIBG scintigraphy was more useful in the detection of extra-adrenal pheochromocytoma. Together with adrenal and extra-adrenal pheochromocytoma, the sensitivity for locating the tumor was calculated as 82 per cent (14/17) for CT and 76 per cent (13/17) for 131I-MIBG scintigraphy, respectively. One adrenal tumor (1 cm in size) only was missed by both methods. No false positive CT scans of 131I-MIBG scintigraphy were obtained in the remaining 10 patients who had possible pheochromocytoma but were excluded. These results indicated that CT and 131I-MIBG scintigraphy were both useful tools for detecting pheochromocytoma.     

Clinical significance of basal-like subtype in triple-negative breast cancer

Background  

No clinically useful target molecule has been identified for triple-negative (TN) breast cancer, i.e., estrogen receptor (ER)-negative, progesterone receptor (PgR)-negative, human epidermal growth factor receptor-2 (HER2)-negative phenotype, and its prognosis is poor. Triple-negative cancer consists of two subtypes: basal-like and non-basal-like. The aim of this study is to clarify the clinical and biological characteristics of these two subtypes of TN cancer.     

A new method of conduction system staining

Visualization of the conduction bundle is advantageous in the prevention of surgical trauma to the conduction system during open-heart surgery. Because vital staining using an iodine starch complex has been known to result in tissue damage, we have evaluated the effects of iodine gas on the specialized conduction system. The conduction bundle was stained, well enough to be identified, with iodine tincture, with Lugol's solution, and with iodine gas. However, all these agents except for iodine gas caused marked electrophysiological changes. Similar changes occurred with the use of ethanol and of 10% potassium iodine solution, which are the solvents of iodine tincture and Lugol's solution, respectively. Microscopic examination showed that iodine tincture, Lugol's solution, and their solvents caused marked histological changes in the conduction tissue. However, no significant changes in the conduction tissue were noted from iodine gas spraying. Therefore, tissue damage caused by iodine tincture and Lugol's solution was thought to be due not to a reaction to the iodine starch complex itself, but to their solvents. In a long-term experimental study of 10 dogs, we found that iodine gas caused no electrophysiological disturbances or damage of microscopic tissue. Of the agents we tested, only iodine gas is free from harmful effects and can be used clinically.     

Calphostins (UCN-1028), novel and specific inhibitors of protein kinase C. I. Fermentation, isolation, physico-chemical properties and biological activities

A novel complex of calphostin (UCN-1028), which specifically inhibits protein kinase C (PKC) has been isolated from the culture broth of a fungi Cladosporium cladosporioides. Purification of individual components was carried out by silica gel, non-porus resin Diaion HP-20SS and Sephadex LH-20 chromatography, leading to isolation of five closely related components. A, B, C, D and I. Calphostins showed cytotoxic activities against various tumor cells, and these cytotoxicities were proportional to their inhibitory activities against PKC.     

Serum gonadotrophin and sex steroid hormone levels during mid-follicular and mid-luteal phases in hyperprolactinaemic women with regular menstrual cycles

Hyperprolactinaemia was found in 15 of 135 infertile patients with regular menstrual cycles, biphasic basal body temperature record and no galactorrhoea. In those 15 women, mean serum prolactin levels during the mid-follicular and mid-luteal phases of the menstrual cycle were 29.8 (SEM 1.8) ng/ml and 29.5 (SEM 1.3) ng/ml, respectively. Although serum FSH and LH levels were similar in normal and hyperprolactinaemic women, serum oestradiol level during the mid-follicular phase was subnormal in hyperprolactinaemic women (P less than 0.05). In contrast, serum oestradiol and progesterone levels during the mid-luteal phase and luteal phase length were similar in normoprolactinaemic and hyperprolactinaemic groups. The results suggest that hyperprolactinaemia is associated with defects of follicle development as measured by oestradiol production during the mid-follicular phase, but not with corpus luteum function as measured by progesterone production during the mid-luteal phase, and luteal phase length.     

Study on pruritus in hemodialysis patients and the antipruritic effect of neurotropin: plasma levels of C3a, C5a, bradykinin and lipid peroxides

The causes of pruritus in patients undergoing hemodialysis and the mechanism of the antipruritic effect of Neurotropin, an extract isolated from the inflamed dermis of rabbits inoculated with vaccinia virus and clinically used in Japan as an analgesic and antiallergic drug, were investigated by measuring the levels of C3a, C5a, bradykinin and lipid peroxides in venous blood collected before dialysis, and at 15 min and 4 hr after starting hemodialysis. C3a increased considerably in pruritic patients compared to non-pruritic patients at 15 min after starting hemodialysis. Neurotropin significantly suppressed the C3a level and improved the condition of pruritic patients. There was no significant difference in the level of bradykinin between pruritic patients and non-pruritic patients. Therefore, bradykinin was not thought to be related to the incidence of pruritus in such patients. A tendency towards lowering of the levels of lipid peroxides in the patients' plasma by Neurotropin was also observed. It seems possible that elevation of C3a may be one of the underlying causes for the appearance of pruritus, and that Neurotropin may exert its antipruritic effect through suppression of the activation of C3 in patients undergoing hemodialysis.     

The discussion of the need of mediastinal lymph node dissection in the surgical treatment of lung cancer

The need of lymph node dissection in the case of operative lung cancer with negative mediastinoscopy was discussed. As a preliminary study, the N-number obtained from the mediastinoscopy and that of postoperative examination was compared. The rate of agreement of N-number was as high as 96%. Secondary, 183 cases of lung cancer with squamous-or adenocarcinoma pathologically T-1 or 2. N-0 and P-0 or 1 were picked up and examined. In those cases, the result of 3 years survival rate was 80% in the cases of absolute curative operation and 60% in that of relative non-curative cases, and 5 years survival rate was 70% and 52% respectively, and the cases of absolute curative operation was statistically excellent than that of another group. However, the background of the two groups was different to some degree on account of the advancement of the cancer and the age of the patients. Therefore, the randomized study as for the lymph node dissection in the cases of negative mediastinoscopy was finally performed. In the 30 cases of squamous cell carcinoma where dissection was carried out in 13 cases and not done in 17 cases, the result of 3 years survival was 84% (dissecting group) and 89% (non-dissecting group), and 5 years survival was 73% and 63% respectively. In 23 cases of adenocarcinoma (13; dissecting, 10; non-dissecting), the result of 3 years survival was 100%, 63% and that of 5 years survival rate was 100%, 63% respectively.(ABSTRACT TRUNCATED AT 250 WORDS)     

Primary atypical mycobacteriosis of the intestine: a report of three cases.

Primary atypical mycobacteriosis of the lung is comparatively common but primary atypical mycobacteriosis of the intestine had not been described previously in the English literature. We have treated three such patients with antituberculous drugs and the clinicopathological findings and course are described. We suggest that these findings may belong to a new clinical entity.     

Predicting the risk of pre-eclampsia and a small-for-gestational-age infant by quantitative assessment of the diastolic notch in uterine artery flow velocity waveforms in unselected women.

OBJECTIVES: To develop a new quantitative index, the notch depth index (NDI), to evaluate its association with the risk of pre-eclampsia and a small-for-gestational-age (SGA) infant and to compare its clinical usefulness with that of the uterine artery resistance index (RI) and the peak systolic to early diastolic velocity (A/C) ratio. METHODS: Uterine artery color Doppler ultrasound was performed in 288 consecutive healthy pregnant women at 20.2 +/- 2.0 (range 16.0-23.9) weeks of gestation. The NDI represents the depth of the early diastolic notch divided by the maximal diastolic velocity. RESULTS: Nine (3.1%) of the 288 women developed pre-eclampsia and 18 women (6.3%) delivered an SGA infant. The NDI was associated with subsequent onset of pre-eclampsia. The optimal cutoff value for the NDI in predicting pre-eclampsia was 0.14, giving a sensitivity, specificity and a positive predictive value (PPV) of 67, 92, and 22%, respectively. The PPV of the NDI was the largest of the three indices evaluated (12% for the RI and 16% for the A/C ratio). The relative risk for pre-eclampsia in women with values equal to or greater than the optimal cutoff values of the RI, A/C ratio and the NDI was 9.7 (95% confidence interval, 2.5-3.7), 19.2 (4.2-91), and 19.2 (5.1-71), respectively. The NDI of 0.14 improved the PPV of 18% determined by the presence of notches in bilateral uterine arteries. The optimal cutoff value of 0.14 for the NDI in predicting an SGA infant yielded a higher PPV (22%) than those for the RI (9%) and A/C ratio (12%). CONCLUSIONS: The NDI value in the second trimester is associated with the later onset of pre-eclampsia, and is clinically more useful in predicting pre-eclampsia than the two conventional indices.