Evaluation of diagnostic criteria of acute renal failure in premature infants

A prospective study was performed to investigate the validity of renal failure index (RFI) or fractional excretion of sodium (FENa) in preterm infants. The subjects were 128 newborn infants, 72 with oliguria and 56 without renal dysfunction (control). Oliguric infants were divided into two categories: acute renal failure (ARF) and prerenal failure (PRF), according to creatinine clearance (Ccr). Furthermore, all subjects were divided into four groups according to gestation, that is, 38 infants with gestational age of 25–28 weeks (group 1), 28 with 29–30 weeks (group 2), 38 with 31–36 weeks (group 3) and 24 of > 37 weeks (group 4). As a result, differentiation between ARF and PRF was valid when the RFI or FENa was used in infants of > 29 weeks gestation (groups 2, 3 and 4). Although infants of > 31 weeks gestation (groups 3 and 4) who present with an RFI > 3 or an FENa > 3% may be diagnosed as having ARF, infants in group 2 with an RFI of > 8 or an FENa of > 6% may be diagnosed as having ARF. For the infants in group 1, the application of RFI or FENa for diagnosis of ARF may be limited because of some overlap among the groups.     

Relationship between Plasma Atrial Natriuretic Peptide Concentrations and Cardio-Thoracic Ratio during the Early Neonatal Period

ABSTRACT. Twenty-seven neonates were examined at 2.6±1.5 hours of age (stage 1) and 21 ±4.9 hours of age (stage 2) to clarify the relationship between cardio-thoracic ratio (CTR) on chest roentgenograms and plasma atrial natriuretic peptide (ANP) concentration. Among 22 infants who showed elevated plasma ANP, 14 had gained body weight (group A), while 8 other infants had lost weight (group B) at stage 2. The remaining 5 infants had decreased plasma ANP concentrations combined with weight loss at stage 2 (group C). All infants of group B had a patent ductus arteriosus. The plasma ANP concentration and CTR of groups A and B increased during the study period, while those of group C decreased. A linear relation was found between plasma ANP concentration and CTR in all cases (p<0.02). This study indicates that increased plasma levels of ANP are associated with an increased CTR.     

Role of Atrial Natriuretic Peptide in the Diuresis of a Newborn Infant with the Syndrome of Inappropriate Antidiuretic Hormone Secretion

ABSTRACT. A fullterm infant had fetal distress and stained amnion. He underwent an exchange blood transfusion at 12 hours after birth because of hyperbilirubinemia. He developed oliguria combined with high urine osmolality during the first 27 hours of life despite normal creatinine clearance. The diagnosis of the syndrome of inappropriate antidiuretic hormone secretion (SIADH) was made on the basis of high urine osmolality, low plasma osmolality and elevated plasma arginine vasopressin (AVP) concentration. We determined the plasma atrial natriuretic peptide (ANP) concentration for the first 4 days of life. After 27 hours after birth, urine volume increased while plasma AVP concentration remained high. On the other hand, plasma ANP concentration gradually increased after 27 hours of life. We speculate that ANP may play an important role in producing the spontaneous diuresis in the newborn infant with SIADH.     

Treatment of aplastic anemia with antithymocyte globulin,cyclosporin A,methylprednisolone, danazole and recombinant human granulocyte-colony stimulating factor

The main purpose of the present study was to determine the response rate to immunosuppressive therapy combined with recombinant human granulocyte-colony stimulating factor (rhG-CSF) and its efficacy for preventing infections in patients with severe aplastic anemia. The treatments included one course of antithymocyte globulin, cyclosporin A, methylprednisolone, danazole and rhG-CSF. Three patients had very severe aplastic anemia and two had moderate aplastic anemia. One patient relapsed 13 months following the first course of therapy and received a second course. Five patients received six courses of treatment and the response rate at 6 months was 83.3%. All patients achieved an absolute neutrophil count of greater than 1.0 × 10⁹/L within 40 days. All patients with a complete response are transfusion-free and doing well. All five patients are currently alive and have not had any episode of infection for 17–53 months. The results of the study indicate that this therapy may improve the poor prognosis of young patients with severe aplastic anemia. It has a good response rate and induces a rather rapid increase in the neutrophil count, which protects against life-threatening bacterial and fungal infections.     

ANGIOGENESIS INHIBITOR TNP-470 INHIBITS GROWTH AND METASTASIS OF A HORMONE-INDEPENDENT RAT PROSTATIC CARCINOMA CELL LINE

Purpose

Inhibitory effects of TNP-470, a synthetic analogue of the antibiotic fumagillin secreted by Aspergillus fumigatus, were studied with respect to growth and lung metastasis of the hormone-independent rat prostatic carcinoma cell line AT6.3.

Materials and Methods

Rat prostatic carcinoma AT6.3 cells were implanted in nude mice subcutaneously. Antimetastatic and growth-inhibitory effects of TNF-470 in vivo were examined 3 weeks after inoculation of AT6.3 cells. Direct growth-inhibitory effect was examined by MTT assay in vitro.

Results

TNP-470 inhibited the growth of AT6.3 cells in vitro. Subcutaneously injected TNP-470 markedly reduced numbers and individual size of lung metastases from AT6.3 cells inoculated percutaneously or intravenously into male BALB/c-nu/nu mice.

Conclusion

This agent, which acts as an angiogenesis inhibitor, may prove to be clinically useful in preventing metastasis of hormone-independent prostatic cancer.     

p53 GENE ALTERATIONS AND p53 PROTEIN IN ORAL EPITHELIAL DYSPLASIA AND SQUAMOUS CELL CARCINOMA

To examine the expression of p53 protein and gene alterations in oral epithelial lesions including epithelial dysplasias and primary squamous cell carcinomas, immunohistochemical and temperature gradient gel electrophoresis (TGGE) methods were applied to formalin-fixed and paraffin-embedded tissues. Morphologically normal mucosal epithelium stained negatively for p53 protein. Three out of 11 (27·3 per cent) epithelial dysplasias and 19 out of 57 (33·3 per cent) primary squamous cell carcinomas stained positively for p53 protein. Although more than half of the cases were positive for p53 protein in stage I, the positive cancer cases were found at other stages with variable frequency. Immunoreactive products were localized in the nucleus, especially in the basal and suprabasal layers. The analysis by TGGE revealed gene alterations in exons 5–8 in 3 out of 3 epithelial dysplasias and 17 out of 19 (89·5 per cent) primary squamous cell carcinomas which were immunohistochemically positive for p53 protein. These results suggest that p53 gene mutation may be involved in carcinogenesis in the oral squamous epithelium even in the early stage of the dysplasia–carcinoma sequence.     

巴西日圆线虫诱导小鼠T辅助细胞的变化对伯氏疟原虫感染的影响

[目的 ]观察预感染巴西日圆线虫后 ,小鼠抵御伯氏疟原虫攻击感染的能力 ,并着重探讨T辅助细胞亚型在感染过程中的变化以及这些变化对宿主免疫力和预后的影响。 [方法 ]皮下注射巴西日圆线虫感染C5 7BL/ 6小鼠 ,建立线虫预感染模型 ,于 3wk后腹腔注射伯氏疟原虫ANKA株攻击感染小鼠。观察每天原虫血症变化情况 ,并于疟原虫感染后 0、3和 9d取脾 ,提取RNA ,用RT PCR扩增法定性观察细胞因子IFN γ和IL 4的变化。[结果 ]与对照组相比 ,实验组感染疟原虫后 ,原虫血症的峰值出现时间明显延长 ,小鼠对疟原虫感染的耐受程度以及小鼠生存时间显著提高。实验组Th2型细胞合成IL 4的量在疟原虫感染 0d时明显高于对照组 ;而在 3与 9d时两组均异常升高。Th1型细胞合成IFN γ的量在疟原虫感染后 3d时实验组高于对照组 ,但在 9d时实验组IFN γ有所下降。 [结论 ]预感染巴西日圆线虫的小鼠具有较高的抗感染能力。但在攻击感染疟原虫后Th2型细胞被提前激活而抑制了Th1型细胞的正常功能 ,最终仍导致小鼠死亡。     

Pancreatic adenosquamous carcinoma, 9 mm in size,diagnosed preoperatively by transpapillary biopsy. Report of a case

Adenosquamous carcinoma of the pancreas is a rare variant of pancreatic cancer, which is known to be difficult to diagnose. We herein report a case diagnosed by transpapillary biopsy of the pancreatic duct. A 73‐year‐old man was referred to our department with suspicion of pancreatic cancer. Ultrasound showed a hypoechoic mass, 9 mm in diameter, in the body of the pancreas. Endoscopic retrograde cholangiopancreatography demonstrated a stenosis of the main pancreatic duct in the body with upstream dilatation and a shift of the bile duct to the left. Histological examination of the specimens obtained by transpapillary biopsy of the pancreatic duct revealed both adenocarcinoma and squamous cell carcinoma. Pancreatoduodenectomy was performed and, histopathologically, the tumor was diagnosed as adenosquamous carcinoma of the pancreatic body, 9 mm in size. This is the first case of adenosquamous carcinoma of the pancreas preoperatively diagnosed by transpapillary biopsy of the pancreatic duct, and the smallest stage I (TNM classification) case of such carcinoma detected to date.     

Scrotal dartos flap for the prevention of the urethrocutaneous fistula on hypospadias urethroplasty

BACKGROUND: Urethrocutaneous fistula is a common complication of urethroplasty for severe hypospadias, even when a microsurgical technique is applied. PATIENTS AND METHODS: From June 2001 to July 2003, we applied the scrotal dartos flap wrapping technique to prevent the occurrence of urethrocutaneous fistula in 14 patients with hypospadias. RESULTS: Hypospadias was repaired without fistula formation in all but one patient, who developed a tiny fistula which was later closed successfully by a simple procedure. CONCLUSIONS: We recommend the scrotal dartos wrapping technique for covering the neourethra with a well-vascularized flap because of fewer complications, although the procedure to obtain the vascularized flap may take longer.