Association of vitamin D and estrogen receptor gene polymorphism with the effects of longterm hormone replacement therapy on bone mineral density

We longitudinally studied whether vitamin D receptor (VDR) and estrogen receptor (ER) gene polymorphisms in Japanese women influenced the effect of longterm hormone replacement therapy (HRT) on bone mineral density (BMD) in the lumbar spine. The 81 subjects were aged 40 to 64 years (mean ± SEM, 49.5 ± 0.6 years), and had received sequential or continuous HRT regimens, including 0.625mg of conjugated equine estrogen and 2.5 to 5mg of medroxy-progesterone acetate, for at least 3 years. Genomic DNA was extracted from blood cells, and analyzed for restriction fragment length polymorphism, using the restriction endonucleases Taq I, Apa I, and Fok I for VDR, and Pvu II and Xba I for ER. At 1 year, subjects with a Taq I genotype of TT (i.e., site absent) showed a significantly greater increase in BMD with treatment (BMD) than subjects with the Tt genotype (2.6 ± 0.5% vs –0.8 ± 1.4%; P = 0.016). A small difference between genotypes remained at 2 years (3.8 ± 0.6% vs 0.8 ± 1.6%; P = 0.069), but no significant difference between genotypes was seen at 3 years. In multiple regression analyses, BMD at 1 year was significantly affected by VDR-Taq I, Apa I, and ER-Pvu II genotypes and by age at treatment initiation, although at 3 years or more, BMD was significantly affected only by age. These results indicate that Taq I VDR gene polymorphism predicted the effect on lumbar BMD for the first year of HRT in Japanese women, and that the differences in BMD versus the polymorphism disappeared if the treatment was continued for over 2 years.     

Bilateral coronary ostial stenosis after aortic valve replacement with freestyle stentless bioprosthesis: a case report

An 80-year-old woman underwent aortic valve replacement with Freestyle stentless prosthetic valve for the stenosis. Four months later, she was admitted with myocardial ischemia. Coronary angiography revealed severe stenosis in the ostium of both right and left coronary arteries. Coronary artery bypass grafting was performed. One year later, percutaneous coronary intervention was carried out for the bilateral coronary arteries because of unstable angina. Intravascular ultrasonography demonstrated localized, membranous, homogeneous, and severe stenoses in the ostium of the right and left coronary arteries. Histological examination of a specimen taken by directional coronary atherectomy showed intimal hypertrophy, mucinous degeneration, and hyaline degeneration without reactive change. There were no findings of atherosclerosis. These clinical, angiographical histological and intravascular ultrasonography findings suggest that the immunological reaction to the heterograft was the mechanism of the bilateral ostial coronary arteries stenoses in the present case. The possibility of immunological reaction after aortic valve replacement with heterograft should be considered. There have been no report on intravascular echocardiographic and histological findings.     

Activation of the prefrontal cortex to trauma-related stimuli measured by near-infrared spectroscopy in posttraumatic stress disorder due to terrorism

To develop a noninvasive method for psychophysiological assessment of posttraumatic stress disorder (PTSD), 34 victims of the Tokyo Subway Sarin Attack in 1995 including 8 diagnosed as PTSD and 12 controls were examined by a multichannel near-infrared spectroscopy (NIRS) system. Hemodynamic response in the prefrontal cortex was monitored during the presentation of trauma-related and control stimuli by video images. Skin conductance response (SCR) was also examined. Oxygenated hemoglobin significantly increased during the trauma-related image in the victims with or without PTSD. Deoxygenated hemoglobin significantly decreased only in victims with PTSD. No significant alteration was found in controls. Significantly enhanced SCR was also observed in the victims with PTSD during trauma-related stimuli. The findings suggest that measurement of cerebral hemodynamic response by NIRS is useful for psychophysiological assessment of PTSD.     

The safety of the donor operation in living-donor liver transplantation: an analysis of 45 donors

We retrospectively assessed the safety of the donor operation, based on parameters such as blood loss, blood transfusion, operation time, duration of hospitalization, and complications. Forty-five pediatric and adult recipients underwent living-donor liver transplantation (LDLTx) in Tohoku University Hospital from July 1991 to October 2000. Donor operations were classified into three groups. In the LS group, the graft was the lateral segment ( n=20); in the LL group, the graft was the left lobe without the middle hepatic vein ( n=16); and in the LLM group, the graft was the left lobe with the middle hepatic vein ( n=9). No significant differences were observed among the three groups regarding postoperative liver function or duration of hospitalization. In the LS group, the operation time was shorter and the requirement of autologous blood transfusion was significantly lower than in the other two groups. Most complications following retrieval of the graft were minor. Safety is guaranteed when the left lobe or the left lateral segment is used for LDLTx, but meticulous management of the operation is required to prevent complications.     

Analysis of acetaminophen glucuronide conjugate accompanied by adduct ion production by liquid chromatography-atmospheric pressure chemical ionization-mass spectrometry

Liquid chromatography-mass spectrometry (LC-MS) is an effective method for the analysis of polar compounds. A coupling of LC-MS, which is used under conventional conditions, and atmospheric-pressure chemical ionization (APCI), which applies mild ionization for the analysis of water-soluble drug conjugates, would offer a very convenient method. The APCI method is effective for ionizing low- and medium-polarized compounds, but not for highly polarized compounds. In this study, we have tried derivatization of carboxyl group of glucuronic acid, to which direct ionization is difficult to apply under the APCI method, was conducted using glucuronides. Methyl ester derivatives were found to be effectively ionized. Furthermore, acetaminophen glucuronide conjugate was investigated in detail. Methyl ester derivatives of acetaminophen glucuronide conjugate (ACEG) were detected at m/z 373 as O(2) adduct ion [M+O(2)](-) in the negative mode, and p-nitrophenyl beta-D-glucuronide (PNPG) demonstrated ionization behaviors very similar to ACEG. Quantitation of ACEG was examined using PNPG as an internal standard, and satisfactory results were obtained for the recovery test and quantification.     

Epidemic nosocomial keratoconjunctivitis caused by adenovirus type 4

PURPOSE: To evaluate the clinical features of nosocomial epidemic keratoconjunctivitis(EKC) occurring in the ophthalmology ward of Sapporo Medical University Hospital and to devise preventive measures for it. MATERIALS AND METHODS: We studied the symptoms and clinical course of 2 patients who had EKC and 16 patients who had EKC caused by nosocomial infections in our hospital. We attempted to detect adenovirus antigen and viral DNA from conjunctival swabs and also to isolate the virus. RESULTS: The clinical symptoms of EKC were conjunctival hyperemia in 18 patients(100%), conjunctival follicles in 11 patients (61.1%), discharge in 8 patients(44.4%), superficial punctate keratopathy in 7 patients(38.9%), swelling of the eyelids in 3 patients(16.7%), and fever in 3 patients(16.7%). 72% were positive for Adeno-check. Adenovirus type 4 was isolated from the conjunctival swabs. We considered that the route of hospital infection was infection from the doctor's hands, from eye drops, and from contact lenses. We disclosed that nosocomical EKC had occurred in our hospital. The hospital infection was eliminated by closing the ophthalmology ward and sterilizing instruments and washing hands. CONCLUSIONS: The delay of proper measures increased the risk of nosocomical infection. We recognized the importance of careful observation of patients and immediate preventive efforts in nosocomical infection.     

Synthesis and antioxidative activity of 6-hydroxypyridoxine

An attempt to synthesize 6-hydroxypyridoxine (OPN), hydroxylation on C-6 of pyridoxine (PN) by hydroxyl radical (OH*). was conducted. Application of two well-known OH* generating reactions, i.e. the Fenton reaction and the Fe2+-EDTA/ascorbate reaction, were unsuccessful, as large amounts of by-products were formed. Although generation of OH* by autoxidation of ascorbic acid in the absence of metal ions was slow, by-products were formed in small quantities, and OPN was easily obtained in colorless crystals. Its structure was confirmed by spectral analyses. OPN was comparable to polyphenols such as (+)-catechin, rutin and gallic acid in the antioxidative activity against linoleic acid peroxidation, and was an effective DPPH radical scavenger, though the DPPH radical-scavenging activity of OPN was somewhat lower than that of the polyphenols. PN was relatively inactive under the conditions used here, indicating that the introduction of a hydroxyl group on C-6 of PN greatly enhanced both activities.     

Transcatheter arterial embolization for bleeding of prostatic artery after prostate biopsy

We present a case of bleeding from the prostatic artery, complicating transrectal ultrasound (TRUS) guided prostate needle biopsy, that responded to transcatheter arterial embolization (TAE). A 62-year-old man with a serum PSA of 4.1 ng/ml was admitted to this institution for a prostate biopsy. He developed hypotension and marked abdominal distension 3 hours after undergoing TRUS guided prostate needle biopsy. CT scanning revealed a massive hematoma extending from the pelvis into the retroperitoneal space. Intra-arterial digital subtraction angiography (IA-DSA) showed extravasation of dye from the right prostatic artery, indicating that it had been damaged during the biopsy procedure. The bleeding was successfully stopped with TAE, using 6 micro coils. TRUS guided prostate biopsy is generally considered a safe procedure, with few complications, and cases of massive hemorrhage into the retroperitoneal space are extremely rare. In cases of arterial retroperitoneal bleeding such as this one, treatment with TAE is fast and accurate.     

Surgical indication and significance of local therapy for first pulmonary metastases from colorectal cancer

We often observe pulmonary metastases in patients following advanced colorectal cancer, especially rectal cancer. The prognoses of LM3 patients and patients with histological v2 factor in the primary site were unfavorable. Surgery was not indicated in these cases. Some patients experienced rapid progression during the standby period for surgery. For the surgery group, we recommend systemic reexaminations after several months. Pulmonary resections for metastatic colorectal cancer are beneficial to the selected patients and 5-year survival rate was 52.6%. New pulmonary relapses were also encountered which were the cause of death among the surgical patients. Close follow-up and multimodal therapy including surgery contributed to longer survival for postoperative pulmonary metastatectomy patients with colorectal cancer.