Simultaneous continuous 13C, 12C analysis of expired gas in the 13C breath test

The ¹³C breath test is a method of clarifying the metabolism of loaded substances by administering ¹³C-labelled materials and calculating the ¹³CO₂ and ¹²CO₂ ratio (¹³C/¹²C isotope ratio) in the expired gas. The materials are metabolized and expelled in the expired gas. Because simultaneous continuous measurement of ¹³CO₂ and ¹²CO₂ in expired gas has been difficult up to the present, respective expired gases, including dead space before and after administration, have been sampled to separate sampling bags and ¹³C/¹²C has been measured in the bags and changed fraction of ¹³C/¹²C after administration (δ) has been used to judge the metabolic process. This method is affected by the contamination of the dead space gas. In the present study, in order to exclude the dead space effect, simultaneous continuous analysis of ¹²CO₂ and ¹³CO₂ of expired gas identifying alveolar gas was applied to the ¹³C-urea breath test in addition to the conventional sampling bag method. Both isotope detectors were attached to a mass spectrometer. Fifty-six cases receiving stomach health check-ups for Helicobacter pylori were examined. δ was calculated in the bag or in phase III of continuous gas measurement. Because the bag contains dead space, δ was reduced and sensitivity and specificity with reference to gastric fluoroscopy or Helicobacter pylori IgG antibody were reduced. Decreasing the dead space contamination is important in reducing the measurement error in the ¹³C breath test and simultaneous continuous measurement is a good tool for this purpose.     

The value of sleep nasendoscopy in the evaluation of patients with suspected sleep-related breathing disorders

Fifty patients with sleep-related breathing disorders were tested with nocturnal polysomnography and with nasendoscopic diurnal polysomnography after diazepam administration, and various indices of breathing disorders were examined, and the results obtained in the two sleep studies compared. There were no significant differences between the two sleep studies in either the type of apnoea or the indices of breathing disorder except for the longest duration of apnoea. There was a significant difference in the duration of REM sleep between the two sleep studies, but no significant difference in the duration of each stage of non-REM sleep. We speculate that nasendoscopic diurnal polysomnography with diazepam can be used as a substitute for nocturnal polysomnography in the clinical study of non-REM sleep stage but it is not sufficient in evaluating REM sleep stage, in patients with sleep-related breathing disorders without pathological obesity or abnormal respiratory function.     

The effects of antiviral agents on serum hepatitis B e antigen levels in chronic type B hepatitis

In the present study, aiming at the evaluation of the effects of antiviral therapy on hepatitis B e antigen (HBeAg) levels, serum HBeAg concentration was determined serially by a quantitative assay in 44 patients with chronic hepatitis B who received a total of 73 courses of antiviral treatment. The posttreatment HBeAg levels were significantly lower than pretreatment baseline in all treated groups, not only at the end of treatment but also 6 months after the completion of therapy. The proportional decrease in treated patients was significantly greater than in 15 untreated controls. Six months after the completion of treatment, serum HBeAg became negative in seven out of 25 treatments with interferon, seven out of 28 with adenine arabinoside, and five out of 20 with adenine arabinoside 5'-monophosphate. All patients who became negative for HBeAg had normalization of alanine aminotransferase as well. A progressive decrease in HBeAg in patients treated with multiple courses of drug was observed, and the frequency of negative tests increased, paralleling the number of courses of treatment. These results suggest that antiviral therapy may alleviate inflammatory changes in the liver by promoting clearance of HBeAg from the serum, and may eventually shorten the natural course of hepatitis associated with chronic hepatitis B virus infection.     

Neuroendocrine features in poorly differentiated endometrioid adenocarcinomas of the endometrium

This study aimed to clarify neuroendocrine features (NEF) in poorly differentiated (G3) endometrioid adenocarcinoma of the endometrium and to evaluate its prognostic significance. Forty cases with G3 carcinoma were investigated for NEF immunohistochemically. The histopathologic specimens were immunostained with chromogranin A, synaptophysin, and leu-7, using the labeled streptavidin-biotin method. The staining pattern was classified into diffuse, partial, or focal. The NEF was compared with clinicopathologic variables, including patients' survival. Chromogranin A was positive diffusely in 1 patient (2.5%), partially in 8 (20%), and focally in 13 (32.5%). Synaptophysin was positive diffusely in one (2.5%), partially in three (7.5%), and focally in nine (22.5%). Leu-7 was focally positive in 10 (25%) patients. The overall positive rate of the three neuroendocrine markers was 62.5%. A patient with diffusely positive staining for both chromogranin A and synaptophysin was diagnosed with neuroendocrine carcinoma. One or more neuroendocrine markers were positive in 25 cases (62.5%). Positive NEF was correlated with clinicopathologic parameters such as stage and myometrial invasion. The survival of the patients with positive NEF, especially with positive leu-7, was significantly lower than that without NEF. NEF was detected immunohistochemically in approximately 63% of the G3 carcinomas, and these patients had a poor prognosis.     

Gestational age assessment in Japanese low birthweight infants

We evaluated the validity of the Ballard scoring system for assessing gestational age in Japanese low birthweight infants. Infants included in this study were 116 neonates who were admitted to seven hospitals in Hokkaido. Gestational ages of all infants were prenatally established by ultrasonographic measurement of the crown-rump length performed between 8 and 12 weeks of gestation (clinical age). Of these, 74 infants were appropriate for gestational age (AGA) and the remaining were small for gestational age (SGA). Mean birthweight was 1703 g and 34% (39/116) were <1500 g. The correlation coefficient for the total population was 0.93 (P < 0.001). Although mean Ballard age tended to overestimate clinical age, mean differences between Ballard age and clinical age did not exceed 0.6 weeks. Agreement within 2 weeks among all infants was 86.2%. Percentages of agreement within 2 weeks did not differ to a statistically significant degree between AGA and SGA. These results indicate that the Ballard method is of value in assessing gestational age in Japanese low birthweight infants.     

乙酰唑胺负荷实验99mTc-HMPAO脑血流灌注显像评价烟雾病的脑血流储备

目的:使用99mTc-HMPAO SPECT及乙酰唑胺(Diamox)负荷显像评价烟雾病(Moyamoya disease)患者的脑血流储备.方法:血管造影诊断为烟雾病人9例(儿童4例,成人5例),6例为短暂性缺血发作(TIA)型,3例为出血型.用99mTc-HMPAO显像,先取安静时图像,之后注入Diamox进行第二次显像,两次图像相减为负荷像,再行图像校正.结果:静息时6例血流低下,3例血流正常,Diamox负荷显像9例中6例阳性,静息像未见异常的3例也全部呈阳性.结论:Diamox负荷实验99mTc-HMPAO SPECT对评价烟雾病的脑循环储备有价值.     

Idiopathic adulthood ductopenia

In 1981, a 26 year old man occasionally demonstrated elevated serum transaminase concentrations. He had no history of medication, or a personal or family history of jaundice, except for prolonged physiological jaundice as a neonate. Serum hepatitis B surface antigen, hepatitis C virus antibody and anti-mitochondrial antibody were absent. A wedge biopsy specimen revealed ductular proliferation, mild inflammation of the portal area and disappearance of bile ducts from 80% of the portal tracts. Serial sections demonstrated a vanishing bile duct. Endoscopic retrograde choledo-chopancreatography, portography and arteriography demonstrated no abnormalities. In 1994, the patient died of hepatic failure following a 12 year observation period. He was subsequently diagnosed with idiopathic adulthood ductopenia on the basis of the criteria proposed by Ludwig.