A case report of intrahepatic portal vein aneurysm; diagnostic usefulness of MRI

A very rare case of portal vein aneurysm in 62 year old female was revealed by various modern imaging modalities including MRI. Diagnostic usefulness of MRI was first demonstrated because of it's high sensitivity to the blood flow as compared with other conventional imaging modalities.     

Comparison of the antimanic efficacy of carbamazepine and lithium carbonate by double-blind controlled study

A multi-institutional study comparing the antimanic effect of carbamazepine (CBZ) and lithium carbonate (Li) was performed using a double-blind group comparison design in a series of 105 patients with bipolar disorders. CBZ and Li were given for four weeks using a fixed-flexible method at an equipotent dose ratio of 1:1, starting from an initial dosage of 400 mg with a maximum dosage of 1200 mg. The final global improvement rate, based on the number of cases showing moderate to marked amelioration of manic symptoms, was 62% in the CBZ group and 59% in the Li group, with no significant difference being found between the two groups. Incidence of cutaneous side-effects was significantly higher in the CBZ group. The mean daily dosage and serum level of CBZ in the fourth week were 674 +/- 239 mg and 7.3 +/- 2.4 micrograms/ml respectively; these were within the therapeutic range. The daily dose and serum level of Li, however, were 710 +/- 239 mg and 0.46 +/- 0.22 mEq/l, and the Li level seemed to be too low to compare its therapeutic effect with that of CBZ. Prior to the present study, approximately 80% of the patients in both groups had been receiving antipsychotic medication, equivalent to 8.0 mg of haloperidol on average, without favorable response. This medication was maintained unchanged during treatment. While the shortcomings of the present study limit the interpretation of the data, it may be suggested that the usefulness of CBZ as a drug for the treatment of manic states is comparable to that of Li.     

Effect of rhG-CSF in the treatment of multiple hepatic abscesses in chronic granulomatous disease]

A 19-year-old male was diagnosed as having chronic granulomatous disease (CGD) based on negative NBT reduction in January, 1988. He was admitted with a chief complaint of high fever in November, 1988. As abdominal echogram and CT scan established a diagnosis of multiple hepatic abscesses, he was treated with various kinds of antibiotics. Since the therapy was ineffective, the number of circulating neutrophils was decreased, and the abscesses further grew, intravenous drip infusion of rhG-CSF 100 micrograms was initiated in addition to several antibiotics (sulfamethoxazole-trimethoprim, rifampicin, isoniazide, etc). At day 3 on rhG-CSF, the fever began to resolve and on day 15 the body temperature fell below 37 degrees C. The hepatic abscesses also tended to decrease in size and the CT scan performed 2 months later (March 17), disclosed only calcification in the liver. The neutrophil function test indicated that superoxide anion (O2-) and hydrogen peroxide (H2O2) production was slightly increased during rhG-CSF therapy. Combination therapy with rhG-CSF and potent antibiotics showed a favorable therapeutic effect on CGD complicated by multiple hepatic abscesses as a fatal infection.     

Ovalbumin-specific induction of IL2 responsiveness in lymphocytes from patients with hen egg allergy and its regulation by the culture supernatant of normal lymphocytes.

Interleukin 2 (IL2) responsiveness of ovalbumin (OVA)-stimulated lymphocytes from patients with hen-egg allergy was studied. The number of viable cells of 5-day cultured lymphocytes stimulated with OVA was increased by an additional three days incubation with recombinant IL2. This phenomenon was not observed when the lymphocytes of patients allergic to OVA but not to Dermatophagoides farinae extract antigen (Df) were stimulated with Df. Normal lymphocytes stimulated with OVA expressed Tac antigen (low affinity IL2 receptor) but, in contrast to those from the allergic patients, did not absorb nor respond to IL2. The induction of OVA-specific IL2 responsiveness in patient lymphocytes was markedly suppressed on the addition of culture supernatant from OVA-stimulated normal T cells, but Df-specific IL2 responsiveness of the lymphocytes from Df-sensitized patients with bronchial asthma was not suppressed by the same supernatant. The supernatant of lymphocytes from allergic patients did not show such suppressive effect. The patient lymphocytes whose IL2 responsiveness was suppressed with the supernatant from normal lymphocytes still expressed Tac antigen. These observations suggest that the culture supernatant of normal T lymphocytes stimulated with OVA contained an antigen-specific factor suppressing the induction of IL2 responsiveness of OVA-stimulated patient lymphocytes. The production of such a suppressive factor was impaired in the patient, and further, the factor may have inhibited the triggering signal of IL2 receptors having absorbed IL2. The existence of some allogeneic barrier between the factor(s) and patient lymphocytes was suggested, since the supernatant from OVA-stimulated normal T cells did not necessarily suppress the response of all patients tested.     

Urinary excretion of sodium and potassium in a screened cohort in Okinawa, Japan.

Information regarding daily intake of sodium (Na) is useful for both normotensive and hypertensive subjects. We measured urinary excretion of sodium (U-Na) and urinary excretion of potassium (U-K) to estimate daily salt intake in a cohort of health screening subjects in Okinawa, Japan. Urine samples were obtained from 2,411 subjects (1,554 men and 857 women) who were examined on a half-day dry-doc at the Okinawa General Health Maintenance Association (OGHMA). Four hundred and one subjects were examined twice, once between September and November in 1997, and once between September and November in 1998. The mean U-Na was 182 mEq/day for men and 176 mEq/day for women. The mean U-K was 54 mEq/day for men and 50 mEq/day for women. U-Na was higher in young men, and U-K was lower in young women. In both men and women, smokers had a significantly lower Na excretion compared to nonsmokers. Subjects treated for hypertension had a significantly lower Na excretion (173 mEq/day) compared to subjects not treated for hypertension (192 mEq/day). Our findings suggest that Na excretion in screened subjects in Okinawa is lower than the national average. Sodium excretion, however, was higher in young men than in elderly subjects, and K excretion was lower in young women than in elderly subjects. Both trends are disadvantageous for controlling hypertension.     

A new three-dimensional automatic bodymarker system for transvaginal ultrasonography.

OBJECTIVE: To evaluate the accuracy and usefulness of a newly developed three-dimensional automatic bodymarker system for transvaginal ultrasonography. METHODS: A bodymarker system which utilizes an electromagnetic field to specify the probe position was developed. Software was written which enabled the positional information of the probe and the ultrasound image to be simultaneously displayed on a personal computer. The bodymarker was displayed as a three-dimensional graphic model. The differences between the estimated and the actual position--i.e. the error--for both position (x, y and z) and angles (azimuth, elevation and roll) of the probe were measured. The movement of the probe was then evaluated in healthy female volunteers and the comparative time required for ultrasound examination was determined. RESULTS: Both the position and the angles of the probe were accurately shown in the computer display. The errors were 1.0 mm and 0.7 degrees (median) for position and angle, respectively. The system was also shown to work well in healthy female volunteers. Calibration of the new system required only 5.0 seconds, compared with an average of 7.6 seconds for the conventional bodymarker. CONCLUSION: The newly developed three-dimensional automatic transvaginal bodymarker system provides an accurate indication of probe position and its tilting angle. It works well in healthy female volunteers and speeds up the examination time. It may be clinically useful for transvaginal ultrasound examination.     

Malignant lymphoma of the ileum

A 53-year-old man with malignant lymphoma of the ileum is reported. He was admitted to our hospital because of lower abdominal discomfort. 67Ga citrate radionuclide imaging revealed an abnormal round uptake in his lower abdomen. CT scans showed an abnormal soft tissue density mass and a remarkably dilated small intestine in the pelvis. X-ray studies of the small intestine revealed a giant diverticulum-like lesion. Angiograms showed a hypovascular tumor with irregularity of the small vessels. A resected specimen revealed non-Hodgkin's malignant lymphoma, diffuse large-cell type. 67Ga citrate radionuclide imaging was useful in screening for neoplastic lesions in the small intestine because of its easiness and safety.     

Cerebral gangliocytoma

Summary We report a case of cerebral gangliocytoma (GC) with a variety of unusual structures in the tumor cells. Light microscopically, the tumor consisted of typical ganglion cells, atypical cells which has argyrophilic granules in the cytoplasm, and a few astrocytes. Electron microscopically, the tumor cells showed typical gangliocytic features, which had abundant rough endoplasmic reticula, ribosomes and cored vesicles of 90–150 nm diameter, a few 50-nm-diametered non-cored vesicles, and other common organelles in their cytoplasm. Furthermore, neoplastic ganglion cells contained a variety of abnormal structures, including membranous cytoplasmic bodies (MCB), Zebra bodies (ZB), tubular structures, branched tubular structures (BTS), concentrical laminated bodies and curvilinear bodies (CB). The MCB, ZB and CB resembled those in GM2 gangliosidosis (GMG), and the BTS that in infantile neuroaxonal dystrophy (INAD). Although the significance of these inclusions is still unknown, it is considered that some common mechanism might play a role in the metabolism of both neoplastic neuronal cells and degenerating neurons (GMG and INAD). Synapses could not be observed anywhere despite complete neuronal differentiation of many tumor cells.     

Intensive individualized induction therapy with behenoyl cytarabine, daunorubicin and 6-mercaptopurine followed by intensive consolidation including intermediate-dose continuous cytarabine, mitoxantron, etoposide and vinca alkaloids in acute myeloid leukemia in adults.

Forty-one consecutive adult patients with acute myeloid leukemia (AML) were treated with an intensive individualized induction therapy of behenoyl cytarabine, daunorubicin, and 6-mercaptopurine, 29 patients (71%) achieved complete remission (CR). Patients then received three courses of intensive consolidation therapy, including intermediate-dose continuous cytarabine (400 mg/m2, for 5 days) and non-cross resistant drugs such as mitoxantron, etoposide and vincristine. During the course of the consolidation therapy, three patients died of infections and one died of myocardial infarction. Four patients underwent allogeneic bone marrow transplantation. The patients then received six courses of moderately intensive maintenance therapy for 1 year. The predicted 5-year continuing CR and disease-free survival rates of the CR patients were 62% (95% confidence limit, 41% to 83%) and 53% (33% to 73%), respectively. Although the number of patients in this study is small, the present study indicated that it may be possible to cure a fairly large proportion of AML patients by chemotherapy alone, if intensive induction therapy is followed by intensive consolidation therapy.