Usefulness of oblique transparent cylinders in facilitating colonoscopy

Recently, the usefulness of the oblique transparent cylinder (OTC) in colonoscopy has been reported. In this study, the efficacy of two newly designed OTCs was evaluated. Colonoscopy performed by six experienced endoscopists in 1005 cases and by one inexperienced endoscopist in 177 cases was analyzed. Short (S) and ultra short (US) cylinders, shorter in length than a conventional long (L) cylinder, were used. The use of OTCs in colonoscopy contributed to a significantly faster insertion into the cecum. The average time to reach the cecum for experienced endoscopists were 12.4 ± 0.3 min without a cylinder, 9.0 ± 0.3 min with a US cylinder, 8.5 ± 0.4 min with an S cylinder and 6.9 ± 0.8 min with an L cylinder, respectively. The visual field and handling of the endoscope were more improved with the S cylinder than the conventional L cylinder. On the other hand, with the L cylinder, the success rate of one inexperienced endoscopist for total colonoscopy reached more than 90% and mean insertion time to reach the cecum was 16.4 ± 1.8 min 7‐months later. Both the success rate and average insertion time for the inexperienced endoscopist were satisfactory considering the rather short learning period. The OTCs were effective in reducing the insertion time. The use of the S cylinder overcame some of the disadvantages of the L cylinder; however, the L cylinder was helpful in improving the technique of an inexperienced endoscopist.     

Renal effects of temocapril hydrochloride (CS-622) in patients with benign nephrosclerosis

SUMMARY: The short-term effects of temocapril, a new angiotensin-converting enzyme inhibitor (ACE-I), on renal function were investigated in 10 patients with benign nephrosclerosis (56.2 ± 7.2 years, mean ± SD). Renal plasma flow and glomerular filtration rate (GFR) were examined before and after 12-week administration, using ¹³¹I-hippuran and ^99mTc-DTPA, respectively. Temocapril (mean 4.5 mg/day) decreased systolic and diastolic blood pressure (from 162 ± 6 to 140 ± 12 mmHg, P <0.001, and from 101 ± 5 to 89 ± 8 mmHg, P <0.001, respectively). Temocapril increased both renal plasma flow (from 323 ± 67 to 367 ± 72 mL/min/1.73 m² P <0.05) and GFR (from 74 ± 14 to 81 ± 15 mL/min/1.73 m², P <0.05). These data show that short-term administration of temocapril improves renal function in patients with benign nephrosclerosis.     

Does transrectal ultrasound guided eight‐core prostate biopsy improve cancer detection rates in patients with prostate‐specific antigen levels of 4.1–10 ng/mL?

BACKGROUND: To investigate retrospectively whether the eight-core biopsy method improves the prostate cancer detection rate when compared with the standard sextant biopsy method in patients with prostate specific antigen (PSA) levels of 4.1-10 ng/mL. MATERIAL AND METHODS: Of 437 patients whose PSA levels ranged from 4.1 to 10 ng/mL, 237 underwent a transrectal ultrasound guided sextant biopsy (sextant group), and 200 underwent an eight-core biopsy (eight-core group). Eight core samples were obtained from each of the far lateral regions in addition to the standard sextant biopsy cores. None of the patients had a previous history of prostate biopsy. RESULTS: Of the 237 patients in the sextant group, prostate cancer was detected in 47 patients (19.8%) and in 50 of the 200 patients in the eight- core group (25.0%). The rates of detection in the two methods were not statistically significant. However, in patients whose PSA density was less than 0.1 ng/mL per cc, the cancer detection rates in the sextant group and the eight-core group were 4.5% and 18.8%, respectively (P = 0.046). The morbidity and complications of the eight-core biopsy method were not notable. CONCLUSIONS: Only in patients with PSA levels of 4.1-10 ng/mL and density of less than 0.1 ng/mL per cc was the eight-core biopsy method an improvement on the sextant biopsy method in terms of prostate cancer detection rate. Accordingly, a number of cores greater than eight will be required to improve the cancer detection rates in patients with PSA levels of 4.1-10 ng/mL and PSA densities of more than 0.1 ng/mL per cc.     

Female para-urethral adenocarcinoma: Histological and immunohistochemical study

BACKGROUND: Female urethral cancer with a diverticular form is assumed to originate from the para-urethral duct, which is embryologically homologous to the male prostate gland. The purpose of the present paper was to investigate the female para-urethral adenocarcinomas histologically and immunohistochemically. METHODS: Surgical specimens obtained from six female patients with para-urethral adenocarcinomas were examined histologically, and an immunohistochemical study using antibodies against carcinoembryonic antigen (CEA), prostate specific antigen (PSA), and chromogranin A was performed. RESULTS: On histologic examination, the female para-urethral cancers were divided into five cases of mucin-producing-type adenocarcinoma and one case of clear cell-type adenocarcinoma. All five mucin-producing-type adenocarcinomas were positive with anti-CEA, and two of them showed neuroendicrine differentiation. One of them showed a focally positive area with anti-PSA. The clear cell-type adenocarcinoma had no positive reactions to these antibodies. CONCLUSIONS: On the basis of histologic structure, positive CEA staining, and the presence of focal neuroendocrine differentiation, mucin-producing-type adenocarcinomas may arise from the proximal part of the para-urethral duct.     

Antitumour Effects and Pharmacokinetics of Combination of Vinblastine with a Staurosporine Derivative,NA-382, in P388/ADR-bearing Mice

The effects of a staurosporine derivative, N-ethoxycarbonyl-7-oxostaurosporine (NA-382), on the pharmacokinetics of vinblastine were evaluated, compared with those of verapamil, in multidrug-resistant P388/ADR-bearing mice. At first, the in-vitro experiments indicated that NA-382 permeated into the cells better and were more effective in combined cytotoxicity with vinblastine and on accumulation of vinblastine than with verapamil in P388/ADR cells. In combined intraperitoneal injection with vinblastine (200 μ kg^?1) into P388/ADR-bearing mice, NA-382 in a suspension form (10 mg kg^?1) prolonged the life-span of the mice near to that of P388/S-bearing mice treated with vinblastine alone, but verapamil even at the maximum tolerated dosage (30 mg kg^?1) barely affected the in-vivo antitumour effect of vinblastine. When simultaneously administered with vinblastine to P388/ADR-bearing mice, NA-382 maintained significantly higher vinblastine levels in the tumour cells for 24 h and gave a larger area under the time-intracellular vinblastine concentration curve (0 to 24 h) than those receiving vinblastine alone, with long retention of the agent in ascitic fluid. Verapamil increased the cellular vinblastine content for only 6 h, accompanying a rapid elimination of the agent from the ascitic fluid. This study indicates that NA-382 is more effective against multidrug-resistance than verapamil, and its suspension is also advantageous for cancer chemotherapy of multidrug-resistant tumours.     

Mortality Among Alcoholics Discharged From a Japanese Hospital

A study of mortality among alcoholics was carried out involving patients discharged from the alcoholic ward of a Hamamatsu University-affiliated hospital from 1972 to 1984 (1021 patients). The average age at death was 48,4 years. The causes of death were divided into three groups; ‘diseases, accidents’, ‘suicide and homicide’, accounting for 73.5%, 10.5% and 7.3% of 257 deaths, respectively. Death rates per 1000 persons for the years at risk were compared with the expected rates for the general population. Briefly, the death rates for patients were more than 10 times as large as those in the general population. Our results showed that liver cirrhosis and heart failure ranked high among the causes of death in alcoholics. Among patients who died, only 3.1% were total abstainers after discharge from hospital, which was an extremely low proportion in comparison with the average cross-total abstinence rate of 25.8% among patients after discharge.     

Fused Inflammatory Polyps Simulating Carcinoma in Ulcerative Colitis

A 33-year old female with a 10-year history of ulcerative colitis developed a large polypoid filling defect in the distal transverse colon, suggestive of carcinoma of the colon. Biopsy indicated an inflammatory polyp but subtotal colectomy was performed because of the long history and the radiographic appearance. Pathologic examination revealed an unusual aggregation of filiform polyps entrapping a semisolid fecal mass. The development of this unique lesion is elaborated.     

Adiponectin is increased and correlated with the degree of proteinuria, but plasma leptin is not changed in patients with chronic glomerulonephritis

Aim:   Altered regulation of adiponectin and leptin may be relevant to endothelial dysfunction and cardiovascular complications in patients with chronic glomerulonephritis.
Methods:   The relationship between the levels of plasma adiponectin, leptin and proteinuria, glomerular filtration rate and metabolic risk factors was investigated in 38 patients with chronic glomerulonephritis.
Results:   Plasma adiponectin was much higher in patients with heavy proteinuria (38.8 ± 27.8 µg/mL) than in patients with mild proteinuria (13.3 ± 5.1 µg/mL, P  < 0.001) and with moderate proteinuria (18.1 ± 8.0 µg/mL, P  < 0.01). The levels of serum leptin were not changed among these groups. Proteinuria and lipoprotein(a) were a strong and direct correlate of plasma adiponectin ( r  = 0.75, P  < 0.0001), while serum albumin and the glomerular filtration rate correlated inversely with this protein ( r  = −0.56, P  = 0.0002; r  = 0.38, P  = 0.02). Body mass index and triglyceride were direct correlates ( r  = 0.37, P  = 0.02 and r  = 0.37, P  = 0.02, respectively) of plasma leptin in patients with glomerulonephritis.
Conclusions:   Plasma adiponectin but not plasma leptin levels correlate with proteinuria in patients with chronic glomerulonephritis.