Imaging diagnosis of genitourinary tract tumors

Recent advance of imaging technique have brought great advantages for management of genitourinary tract tumors. We described few examples of changes in this field from our experience. Many asymptomatic masses are discovered in the kidney and adrenal gland associated with wide clinical application of CT and US. In the kidney, the greater part of incidental masses are renal cell carcinomas (RCC) and the rate of such cases has been increasing. When small RCC is diagnosed without any clinical symptoms, better survival would be expected. Many adrenal incidental mass are also discovered by routine use of CT for abdominal workup. Since greater part of these masses are benign nonfunctioning adenomas, correct diagnosis should be made in order to avoid inappropriate surgery. Rapid development of MR also resulted in some changes in the diagnosis of urinary tract tumors. However, MR cannot be used as a screening method. For staging of RCC, intravascular or adjacent organ invasion was well determined with MR compared with CT. Differentiation of adrenal carcinomas from nonfunctioning adenomas is suggested by the difference of signal intensity on T2 weighted images. Fast spin echo scan with GD-DTPA enhancement is new MRI technique separating bladder mucosal layer from muscle layer as hyper-intensity area. Using this method, diagnostic accuracy of deep muscle invasion for bladder tumor would be improved.     

Osteonecrosis following radiotherapy in carcinoma of the uterus and pediatric tumors

Osteonecrosis following radiation therapy in 611 Patients with uterine cancer and 41 patients with pediatric tumor were studied. The 5- and 10-year cumulative bone injury rate after radiation therapy in uterine cancer was 4% and 15.6%, respectedly. Patients who are older than 60 years of age showed high occurrence of radiation bone injury. Otherwise, severe aletrations in shape and complete arrest of growth in irradiated growing bone were observed of even with small doses of 1600 cGy in the lower age level (0-3 age of years) at the time of treatment.     

Comparison of the effects of MCI-154, a new cardiotonic agent, and some Ca2+-sensitizing agents on the response of the contractile system to Ca2+ in skinned cardiac muscle

Several cardiotonic agents (MCI-154, sulmazole, pimobendan and adibendan) were examined for their ability to influence Ca2+-activated tension development and MgATP-activated tension development in the absence of free Ca2+ (rigor tension), using the chemically skinned fiber from guinea pig papillary muscles. MCI-154, sulmazole, pimobendan and adibendan all increased the tension development induced by pCa (-log[Ca2+]M) 5.8 in a concentration-dependent manner (10(-6) to 10(-4) M). The order of the potency was as follows: MCI-154 greater than pimobendan greater than adibendan greater than sulmazole. MCI-154 enhanced the maximum tension developed at pCa 4.4 but sulmazole, pimobendan and adibendan did not enhance it. MCI-154, but not sulmazole, pimobendan and adibendan, enhanced the tension development induced by pMgATP (-log[MgATP]M) 6.0 in the absence of free Ca2+. MCI-154, sulmazole, pimobendan and adibendan concentration-dependently (10(-7) to 10(-4) M) increased the force of contraction in isolated guinea pig papillary muscles. The order of the potency was as follows: MCI-154 greater than adibendan greater than pimobendan greater than sulmazole. These results demonstrated that the Ca2+-sensitizing action on the contractile system may be involved in the positive inotropic action of MCI-154, sulmazole, pimobendan and adibendan, and that MCI-154 is the most potent among these drugs. Furthermore, sulmazole, pimobendan and adibendan did not enhance the interaction of actin and myosin, suggesting that the mechanism of actions of these drugs are qualitatively different from that of MCI-154.     

Effects of nifedipine,a potent calcium-antagonistic coronary vasodilator,on atrioventricular conduction and blood flow in the isolated atrioventricular node preparation of the dog

Summary The effects of the calcium-antagonist nifedipine on atrioventricular (A-V) conduction and blood flow were investigated in comparison with those of verapamil by the use of the isolated, arterially blood-perfused A-V node preparation of the dog. Single injections of 0.3–30 g of nifedipine and verapamil into the A-V node artery produced a dose-related increase in the A-V conduction time and at 30 g the two drugs caused second degree block of A-V conduction. The results are compatible with the hypothesis that a slow calcium channel plays an important role in excitation of A-V nodal cells. The rate of blood flow through the A-V node artery was about 10 times more sensitive to nifedipine than was the A-V conduction time and increased in a dose-related manner. In contrast, an increase in blood flow rate by verapamil occurred in almost the same dose range as did impairment of A-V conduction. This indicates that the action of nifedipine is more pronounced on coronary smooth muscle cells than on the A-V nodal cells.     

Isolation and genotype analysis of rubella virus from a case of Guillain-Barré syndrome

Rubella virus (RV) infection has sporadically been linked to Guillain-Barré syndrome (GBS), but the association with RV has been based only on clinical and/or serological backgrounds. In the present case it was possible to isolate RV (genotype 1a) from cerebrospinal fluid and peripheral blood mononuclear cells of an 18-year-old woman diagnosed with GBS after clinical manifestations of rubella. This report contributes to confirm RV as one of the triggering pathogens of this peripheral nervous system disease.     

Onset of vecuronium neuromuscular blockade at the hand with an arterio-venous shunt

Purpose

To evaluate the onset of vecuronium neuromuscular blockade in the hand with an arteno-venous shunt for haemodialysis.

Methods

In 15 adult patients receiving haemodialysis for renal failure the onset of vecuronium-induced neuromuscular blockade after 0.08 mg·kg^?1 vecuroniumiv was measured. Using train-of-four mechanomyographic monitoring, the force of contraction of the adductor pollicis of both hands with and without arteno-venous shunt was measured simultaneously.

Results

The times from the injection to the first depression of twitch response (latent onset) and 95% twitch depression (onset) in the hand with and without arteno-venous shunt were114.7 ± 33.4 and 218.7 ± 59.9 and 117.3 ± 34.3 and 208.7 ± 60.9 sec respectively. No difference in the onset of vecuronium neuromuscular blockade in the hand an arterio-venous shunt was demonstrated.

Conclusion

The presence of an artenovenous fistula does not modify the onset on neuromuscular blockade. Either arm can be used to monitor onset of neuromuscular blockade in chronic renal failure patients with an arterio-venous shunt in the hand for haemodialysis