Adjuvant chemotherapy of paclitaxel plus carboplatin in uterine corpus cancer--comparison with cisplatin, adriamycin plus cyclophosphamide

The therapeutic efficacy and adverse reactions were compared between 14 patients who received TJ therapy using paclitaxel (PTX) and carboplatin (CBDCA) and 39 who received CAP therapy using cyclophosphamide (CPA), doxorubicin (DXR) and cisplatin (CDDP) as postoperative chemotherapy for cancer of the uterine body. In TJ therapy, PTX (175 mg/m(2)) and CBDCA (AUC 5) were administered on Day 1 (every 3 weeks), while in CAP therapy, CPA (500 mg/m(2)), DXR (40 mg/m(2)) and CDDP (50 mg/m(2)) were administered on Day 1 (every 4 weeks). Grade 3 or more severe hematotoxicity included leukocytopenia (incidence in the TJ and CAP groups: 71.4% and 64.1%, respectively), neutropenia (100%, 87.1%), thrombocytopenia (0%, 12.8%), and anemia (0%, 20.5%). No significant differences were noted between the two groups. Grade 3 or severe non-hematologic toxicities included nausea (0%, 15.4%) and vomiting (0%, 12.8%) with significantly higher incidence in the CAP therapy group (p=0.0000736, p=0.000736), peripheral sensory disturbance (7.1%, 0%) and arthralgia (7.1%, 0%) with significantly higher incidence in the TJ therapy group (p=0.00129, p=0.00000538). The survival rate and disease-free survival rate showed no significant differences between the two groups. TJ therapy is thought to be as effective as CAP therapy, and can be safely conducted, although precautions are required regarding arthralgia and neuropathy.     

Magnetic resonance imaging of cerebral fat embolism

Summary The cerebral fat embolism is a potentially serious complication of fractures but clinical cases often go undiagnosed. Two cases of clinically diagnosed cerebral fat embolism are reported, and MR images of these patients are described. While brain CT revealed no abnormality, MR imaging showed relative low-intensity areas on T1-weighted images and high-intensity areas on T2-weighted images. In one patient follow-up MR showed nearly complete resolution of the abnormal signal. MR imaging appears to be valuable for detecting the lesions in these patients.     

The use of an ileostomy connector to diminish the frequency of defecation prior to ileostomy closure in patients with a pelvic pouch

A new method for allowing stool passage into the pelvic pouch before ileostomy closure to verify the defecation state and diminish stool frequency is reported herein. This was accomplished by fitting an ileostomy connector connecting the proximal and distal openings of the diverting loop stoma. The ileostomy connector was initially in place for 6 h a day, the length of time being gradually increased until it was able to be left in for 24 h a day over a 3-month period. The calculated daily frequency of stools decreased from 24 to 6 or 7 times, and the mean daily frequency immediately after ileostomy closure was 6.5 times. Physiological study also showed an improvement, with squeeze pressure increasing from 35 cmH₂O to 116 cmH₂O and the maximum tolerated volume increasing from 35 ml before, to 90 ml 3 months following the use of an ileostomy connector. Thus, we conclude that an ileostomy connector may be useful to predict postoperative functional outcome and its complications, and to diminish the frequency of defecation before ileostomy closure in patients with a covering loop stoma.This study was submitted as a poster presentation at the meeting of the XIVth Biennial Congress of the University of Colon and Rectal Surgeons in Creta, Greece, October 25–29, 1992.     

Ultrastructural effects of granulocyte colony stimulating factor (G-CSF) and macrophage colony stimulating factor (M-CSF) on rat neutrophils and monocytes

Human granulocyte colony stimulating factor (G-CSF) and macrophage colony stimulating factor (M-CSF) were administered intravenously to rats, and their effects on neutrophils and monocytes were examined by electron microscopy. G-CSF increased the number of cytoplasmic granules in neutrophils. It also enhanced maturation of the nuclear shape in the neutrophils, while chromatin condensation and peroxidase distribution remained immature. M-CSF induced proliferation of monocytes in peripheral blood and bone marrow, but did not affect morphology or distribution of peroxidase reactivity. This study was presented at the 25th Annual Meeting of the Clinical Electron Microscopy Society of Japan, Matsumoto, September 28–30, 1993.     

Induction of CD5 antigen on human CD5 B cells by stimulation with Staphylococcus aureus Cowan strain I

We have examined whether the CD5 phenotype could be inducedon human B cell surfaces by the polycional B cell stimulator,Staphyiococcus aureus Cowan strain I (SAC). Fresh tonsillarB cells were prepared by Percoll density gradient from E^–cells. The proportion of CD5⁺ B cells In the 50/60% and 60/70%interface high-density fractions varied between 1.2 and 10.2%depending on the tonsil preparations when they were placed onthe in vitro culture 12–60 h prior to flow cytometrlcanalysis. The expression of CD5 antigen obviously increasedin the presence of SAC (1:10⁵ v/v). The percentage of CD5⁺ Bcells varied from tonsil to tonsil, from 25.1 to 65.9% in aseries of experiments. The CD5⁺ B cells were found both amongCD23⁺CD25⁺CD71⁺ and CD23^–CD25^–CD71^– B cells.The level of CD5 expression was related to the cell size eniargement.The addition of anti-CD5 antibody in the culture blocked theCD5 induction by SAC without interfering with the expressionof other activation markers. A time-course study showed thatCD5 antigen appeared to be induced on the cell surface duringthe G₀ to G₁ phase transition in the cell cycle. When CD5⁺ andCD5^– B cells were separated by magnetic isolation, theCD5^– B cells showed DNA synthesis to the stimulation bySAC and expressed CD5 antigen on their cell surface. These resultssuggest that human CD5^– B cells can express the CD5 phenotypeby stimulationwith the polyclonal B cell stimulator, SAC.     

Torsion of the gallbladder: Computed tomographic findings

We report two cases of gallbladder torsion. Computed tomographic findings included marked dilatation, wall thickening, and intraluminal membranous structure of the gallbladder. The extrahepatic bile duct was also dilated.     

Optimal placement of CVP catheter in paediatric cardiac patients

For correct monitoring of central venous pressure (CVP) the tip of the CVP catheter should be placed in the superior vena cava (SVC). Since there is no useful guide for the optimal depth of insertion of CVP catheter in children undergoing cardio-vascular surgery, we examined the relationship between the depth of the CVP catheter and easily measured body-size variables, such as age, weight and height, and then created a guide for the optimal placement of the paediatric population. The CVP catheterization was performed through the right internal jugular vein by the high approach. The position of the catheter tip was determined by the wave form of the CVP tracing and the depth of insertion was assessed by the external marking on the catheter at the cannulation site. The position of the catheter tip, determined by postoperative AP chest x-ray, was identified by the level of thoracic vertebra (T) corresponding to the position of the catheter tip. We analyzed the relationship between the depth of the catheter and patient’s age, weight and height by linear regression analysis. The position of tip was normally distributed from T₁ to T₇ and the tips were centralized at levels of T₃ T₄ and T₅ which anatomically correspond to SVC. The r values between the catheter depth and the three factors at each level were comparable, although the correlation between the depth of catheter and height was best. A simple guide for placement of the catheter tip at T₃, T₄ and T₅ levels as a function of patient’s height was created. Since height is a primary information variable which is available even in emergency cases, we believe that the guide is acceptable and valuable to anaesthetists.