Acute myeloblastic leukemia and hepatocellular carcinoma following Waldenstr?m's macroglobulinemia

A 54-year-old man was admitted to our hospital for precise examination of pancytopenia in October 1988. He had been cut off his left femur and irradiated because of osteosarcoma in 1954. After 30 years, he was diagnosed as Waldenstr?m's macroglobulinemia. Melphalan had been given 2 mg daily for 19 months until August 1988, when it was discontinued due to pancytopenia. Peripheral blood showed Hb 6.6 g/dl, platelet 40 x 10(3)/microliters, and WBC 2000/microliters with 33% blasts. Bone marrow showed normocellularity with 36% blasts. Although blasts were negative for peroxidase staining, surface marker analysis revealed myeloid (CD 13, CD 33) phenotypes. Chromosome analysis showed 45, XY, -7, inv (3). A CT scan of the liver showed a mass, 10 by 10 cm, compatible with hepatocellular carcinoma. He was treated with very low dose Ara-C without noticeable effect. Hepatic tumor gradually enlarged, and he died of hepatic failure. This is a rare case of quadruplicate malignancies. The chromosomal abnormality suggests that AML was secondary leukemia which might be associated with immunosuppression due to macroglobulinemia and/or melphalan therapy.     

Active and Passive Cutaneous Anaphylaxis in Wbb6f1 Mouse, A Mast Cell-Deficient Strain

WBB6F₁ mouse, a mast cell-deficient strain, was tested for active and passive cutaneous anaphylactic reactions. Active cutaneous anaphylaxis was not produced in mice which had been immunized for 1 to 2 weeks by an intraperitoneal injection of bovine serum albumin with either adjuvant, Freund's complete adjuvant or Bordetella pertussis organisms, even though circulatory IgE and IgG₁ antibodies were raised. Passive cutaneous anaphylaxis (PCA) was also absent, when the mice had been sensitized with allogeneic IgE or IgG₁ monoclonal antibodies. However, obvious PCA was produced when allogeneic or xenogeneic hyperimmune serum was employed. These findings indicate that mast cells are not necessarily needed for the production of PCA. Some mechanism quite different from the well-elucidated mechanism, i.e., IgE-or IgG₁ antibody-triggered histamine release from mast cells, seems to be operative.     

Effects of HNS-32, a novel antiarrhythmic agent, on guinea-pig myocardium.

The electrophysiological and mechanical effects of HNS-32, a novel azulene-1-carboxamidine derivative with antiarrhythmic activity, were studied in isolated guinea-pig myocardial preparations. HNS-32 (10(-6)-10(-4) mol/l) concentration-dependently decreased the maximum rate of rise (V(max)) of action potential in isolated papillary muscle; the potency was the same or slightly higher than that of disopyramide. At 10(-4) mol/l, HNS-32 also shortened the action potential duration (APD) and depolarized the resting membrane potential; these effects were similar to those of 10(-5) mol/l verapamil. HNS-32 (10(-7)-10(-4) mol/l), as well as verapamil (10(-8)-10(-5) mol/l) and disopyramide (10(-6)-10(-3) mol/l), had concentration-dependent negative chronotropic and negative inotropic effects on isolated right atrial and right ventricular papillary muscle preparations, respectively. The concentration-response relationship for the positive chronotropic effect of isoproterenol was not affected by HNS-32 (10(-5) mol/l). In isolated ventricular myocytes, HNS-32 (10(-6)-10(-4) mol/l) concentration-dependently inhibited the peak amplitude of the L-type Ca(2+) current. These results suggest that NHS-32 has V(max) reducing activity on myocardial tissue, which may be responsible for antiarrhythmic effect. The drug may also have additional effect on the Ca(2+) channel at higher concentrations.     

Inflammatory granulomas extending from the sphenoid sinus to the cavernous sinus: report of three cases]

We treated three cases of inflammatory granulomas extending from the sphenoid sinus to the cavernous sinus. Case 1 was that of a 36-year-old male with diplopia and right ptosis. Case 2 was that of a 40-year-old male with frontal headache. Case 3 was that of a 70-year-old female with left impaired vision and frontal headache. In the first case, MRI demonstrated a mass lesion extending from the right half of the sphenoid sinus to the cavernous sinus and retropharyngeal space. In the second case the granuloma extended from the right cavernous sinus to the right retroorbital space. In the last case, MRI demonstrated diffuse Gd-DTPA enhancement of the left cavernous sinus and the left half of the sphenoid sinus. In all cases an operation was performed using the sublabial rhinoseptal approach, and the tumor in the sphenoid sinus was removed. Histological examination revealed an inflammatory granuloma in all 3 cases. In the first case the clinical symptoms improved following administration of glucocorticoids. In the second case the mass in the cavernous sinus decreased in size postoperatively. In the last case, the clinical symptoms gradually improved with administration of antibiotics after surgery. Granuloma of the cavernous sinus is difficult to diagnose, but when a similar pathological lesion coexists in the sphenoid sinus, a definitive diagnosis can be easily made via the sublabial rhinoseptal approach.     

Effect of topical 8-hydroxy carteolol on intraocular pressure and melanin granules

It was reported that 8-Hydroxycarteolol (8-OH CA), the major metabolite of carteolol hydroxychloride (CA), has a slightly different pharmacological effect from CA. We studied the reduction of intraocular pressure (IOP) on a single eyedrop application of 8-OH CA in albino and pigmented rabbit eyes. To determine the characteristic of 8-OH CA and CA, we investigated the binding ability of these drugs to synthetic melanin. In the present study, topically applied 2% CA did not significantly decrease IOP in albino and pigmented rabbit eyes. Topically applied 0.01, 0.05, 0.1 and 1.0% 8-OH CA significantly decreased the IOP of albino rabbit as did 0.1 and 1.0% 8-OH to pigmented rabbit eyes. The maximum reduction of IOP was 3.5 +/- 0.33 mmHg (mean +/- SEM) in albino rabbit and 3.0 +/- 0.45 mmHg (mean +/- SEM) in pigmented rabbit. Maximum IOP reduction was obtained after 30 min. from topical application in albino rabbit, but in pigmented rabbit after 1 hour or later. Our binding studies to melanin show that the melanin binding ability is less for 8-OH CA than for CA at any concentrations. These results may indicate that lower concentrations of topically applied 8-OH CA profoundly reduce IOP compared to CA, and 8-OH CA has less effect on melanin than CA.     

Analytical studies of both initial symptoms and clinical symptoms and signs of different etiologies of chronic pancreatitis: an approach by using odds ratios]

We conducted the statistical analysis of both initial symptoms and clinical symptoms and signs of different etiologies of chronic pancreatitis by using odds ratios which was one of the techniques of evidence-based medicine. The official report published by The Research Group of Intractable Pancreatic Diseases sponsored by the Welfare Ministry of Japan in 1986 was available as the data source of the present study. Nine items of initial symptoms and 25 items of 28 clinical symptoms and signs were compared in 4 different etiologies of the disease which were alcoholic, biliary, idiopatic and nonalcoholic (both biliary and idiopatic). In initial symptoms, 1.5 items were significantly more observed in alcoholic pancreatitis than in nonalcoholic, biliary and idioatic pancreatitis, 4 of which (abdominal pain, back pain, poor appetite and loss of body weight) were common items as might be related closely to the alcohol intake, 2. only one item of jaundice was significantly more observed in biliary pancreatitis than in alcoholic and idiopatic pancreatitis, 3.3 items of poor appetite, diarrhea and abdominal mass were more frequently observed in idiopatic pancreatitis than in biliary pancreatitis. In clinical symptoms and signs, 1. almost all items (21 to 24) were significantly more observed in alcoholic pancreatitis than in the other etiologies of the disease, and seemed to be related directly or indirectly to alcohol intake, 2.3 or 4 items which were related closely to gallstone and acute cholecystitis were significantly more observed in biliary pancreatitis than the other two etiologies of the disease, and 3.4 items consisting of diarrhea, loss of body weight, and pancreatic swelling were more frequently observed in idiopathic pancreatitis than in biliary pancreatitis.     

Clinical results of thermoradiotherapy for locally advanced and/or recurrent breast cancer--comparison of results with radiotherapy alone

From August 1979 until 1988, 26 breast cancer patients with 30 tumours were treated by hyperthermia in combination with radiotherapy. Of the 30 tumours, 11 were locally advanced primary tumours (group 1), six were locally advanced recurrent tumours after operation (group 2) and 13 were locally recurrent tumours after radiotherapy (group 3). The thermal profiles showed that the capability of an RF capacitive heating device is comparatively high for large breast tumours with a volume of more than 100 cm3, and that of a 430 MHz microwave device with a single-lens applicator is excellent for localized tumours. The response rate of group 1 and 2 tumours was excellent, and superior to that of historically controlled tumours that were treated by radiotherapy alone from July 1962 until August 1979. In group 3 the tumour response to thermoradiotherapy was not different from that to radiotherapy, but the possibility of significantly reducing total irradiation dose was indicated. More than one good heating session led to a significantly high local response, and factors having a tendency to influence local response were average minimum tumour temperature, tumour volume, and number of effective heat treatments.     

Automatic detection and measurement of EMG silent periods in masticatory muscles during chewing in man.

Silent periods are transient stops of muscle activity that are induced by mechanical or electrical stimulus. The current report describes a new algorithm which enables automatic detection and measurement of silent periods that occur in the EMG of human masticatory muscles during chewing efforts together with jaw positions in space at the occurrence of the silent periods. The EMG signal for detection of the silent period is modeled based on the observation of the EMG records induced from the jaw-closing muscles during chewing efforts in seven volunteer subjects. The algorithm for automatic detection and measurement of the EMG silent period has been applied successfully to real EMG data and the performance of the software was confirmed to be sufficiently reliable. The results of the analysis are stored in a biosignal database for possible clinical use.