Accurate Assessment of Breast Volume by Computed Tomography Using Three-dimensional Imaging Device

Preoperative assessment of breast volume could contribute significantly to the planning of breast reconstructive surgery. However, breast volume measurements are not carried out on a routine basis, because there is still no commonly accepted standard method for such measurements. In the current study, we assessed whether routine computed tomography (CT) of the chest using a three-dimensional device could provide accurate estimation of breast volumes in patients with breast cancer. Ten consecutive patients and 11 breasts with breast cancer that underwent mastectomy with immediate breast reconstruction were enrolled in this study. In each case, a three-dimensional image was constructed according to the CT data using a volume-rendering technique. Computed breast volumes were compared with known breast volumes obtained from surgical specimens. The mean breast volume of surgical specimens was 324.1 ± 173.5 mL. The mean breast volume value was established to be 351.6 ± 174.3 mL with three-dimensional CT in a novel method. There was a strong linear association between breast volumes of surgical specimens and breast volumes measured by the three-dimensional CT method when using a Pearson correlation (r = 0.985, P < 0.001). Our results suggest that the calculation of breast volume using three-dimensional CT is accurate enough to have a significant clinical benefit in planning reconstructive breast surgery. This method can help the surgeon predict the esthetic effect of various breast surgeries and guide the choice of the most appropriate implant preoperatively.     

Regulation of mitochondrial biogenesis by lipoprotein lipase in muscle of insulin-resistant offspring of parents with type 2 diabetes

Recent studies reveal a strong relationship between reduced mitochondrial content and insulin resistance in human skeletal muscle, although the underlying factors responsible for this association remain unknown. To address this question, we analyzed muscle biopsy samples from young, lean, insulin resistant (IR) offspring of parents with type 2 diabetes and control subjects by microarray analyses and found significant differences in expression of ~512 probe pairs. We then screened these genes for their potential involvement in the regulation of mitochondrial biogenesis using RNA interference and found that mRNA and protein expression of lipoprotein lipase (LPL) in skeletal muscle was significantly decreased in the IR offspring and was associated with decreased mitochondrial density. Furthermore, we show that LPL knockdown in muscle cells decreased mitochondrial content by effectively decreasing fatty acid delivery and subsequent activation of peroxisome proliferator-activated receptor (PPAR)-δ. Taken together, these data suggest that decreased mitochondrial content in muscle of IR offspring may be due in part to reductions in LPL expression in skeletal muscle resulting in decreased PPAR-δ activation.     

Relationship between tongue strength and 1-year life expectancy in elderly people needing nursing care

Tongue strength is a useful indicator of oral function and has been found to decrease with aging and reduced physical functioning. The present study aimed to assess the relationships of tongue strength with physical function, mental function, and nutritional status, and also between these factors and 1-year outcomes, to determine whether tongue strength is related to life expectancy in elderly people needing nursing care. The subjects were 140 elderly individuals requiring needing nursing care (49 men and 91 women; ≥65 years). The investigated items included sex, age, activities of daily living (ADL), comorbidity, cognitive function, nutritional status, eating function, occlusal support, and tongue strength. Furthermore, a follow-up study was conducted 1 year later, and factors related to death were identified. The mean tongue strength of the total 140 subjects was 20.3 ± 8.6 kPa. Tongue strength was assessed relative to each of the investigated items, using the t test and one-way analysis of variance. Tongue strength was significantly related to ADL, comorbidity, cognitive function, calf circumference, food intake, and occlusal support. Fifteen subjects were found to have died at the 1-year follow-up study. We assessed the relationships of 1-year outcomes with each of the factors examined, and 1-year outcomes were found to be significantly related to ADL and tongue strength.     

High plasma pancreastatinlike immunoreactivity in a patient with malignant insulinoma

High levels of pancreastatinlike immunoreactivity were detected in the plasma (2.9 pmol/ml, greater than 200-fold the normal level), pancreas (2.9 nmol/g wet wt, greater than 450-fold the normal level), and liver (1.6 nmol/g wet wt) of a patient with pancreatic insulinoma with metastasis to the liver by a sensitive and specific radioimmunoassay for human pancreastatin. Antiserum was produced against the C-terminal fragment of human pancreastatin-(24-52), which was synthesized according to the sequence of human chromogranin A corresponding to that of pancreastatin. With the antiserum, intense immunocytochemical staining was detected in the tumors. Sephadex G-50 gel filtration showed that the tumors and plasma contained two molecular forms of pancreastatinlike immunoreactivity--a molecular form coeluted with synthetic human pancreastatin-52 and a larger molecular form (Mr approximately 12,000-15,000). The smaller form eluted in the same position as synthetic human pancreastatin-52 on reverse-phase high-performance liquid chromatography.     

Prospective evaluation for upper gastrointestinal tract acute graft-versus-host disease after hematopoietic stem cell transplantation

The incidence and clinical significance of upper gastrointestinal tract acute graft-versus-host disease (upper GI GVHD) were prospectively evaluated in 44 Japanese patients who underwent allogeneic (n = 26) or autologous (n = 18) stem cell transplantation. Endoscopic examination was routinely performed between days 20 and 50 post-transplant and when symptoms of upper GI and/or acute GVHD of other organs were present. The results were compared with the historical records of 49 allograft and 20 autograft recipients. The diagnosis of upper GI GVHD was confirmed by histologic findings of GVHD and persistent upper GI tract symptoms. The incidence of upper GI GVHD was 46% in the prospective allograft group, higher than in the retrospective group. Upper GI GVHD was not diagnosed in any autograft patients. Twelve of 19 patients with upper GI GVHD had skin GVHD, and two of the 12 had concurrent lower GI GVHD. Upper GI GVHD was successfully treated with steroids and did not progress to symptomatic lower GI GVHD. In addition, upper GI GVHD completely resolved without specific alteration in immunosuppressant therapy in six patients. No risk factors for upper GI GVHD could be identified. The presence of upper GI GVHD did not significantly affect early death rate, incidence of chronic GVHD, and overall survival. In conclusion, by the prospective evaluation of the upper GI tract by endoscopy we could accurately diagnose upper GI GVHD in half our allogeneic recipients. However, upper GI GVHD was successfully controlled with or without additional steroids in all cases and had little impact on transplant outcome.     

Paradoxical brain embolism caused by pulmonary arteriovenous fistula and coincident pulmonary embolism--a case report

The authors encountered a very rare case of paradoxical brain embolism resulting from pulmonary arteriovenous fistula and coincident pulmonary embolism. Enhanced computed tomography was useful for diagnosing this infrequent condition.     

Effects of synthetic human gastrin-releasing peptide on pancreatic exocrine secretion and release of pancreatic polypeptide in conscious rats

The effects of a newly synthesized peptide, human gastrin-releasing peptide (hGRP), on the pancreatic exocrine secretion and the release of pancreatic polypeptide (PP) were examined in the conscious rat. Plasma PP concentrations were determined by a recently established specific radioimmunoassay for rat PP. Amounts of 0.18, 0.35, and 3.5 nmol/kg/h hGRP significantly stimulated both pancreatic exocrine secretion and 0.35 nmol/kg/h of hGRP increased PP release. Simultaneously infused proglumide (300 mg/kg/h) did not affect either pancreatic exocrine secretion or PP release. However, simultaneous infusion of atropine (100 micrograms/kg/h) slightly inhibited PP release, but did not restrict the incremental response of pancreatic protein secretion to hGRP. These results suggest that hGRP directly stimulates pancreatic exocrine secretion and PP release.     

Immunological aspects of secretory otitis media in Iranian children, immunoglobulin and complement concentration in serum and glue

Otitis media with effusion (OME) is a very common pediatric disease with unknown etiology which sometimes leads to chronic recurrent OME. Immune reactions in serum and in the middle ear system play roles in the etiology, pathogenesis, and prevention of otitis media. The middle ear mucosa has a secretory immune system similar to those of other areas of the respiratory tract, except that it does not have lymphoid follicles. Otitis media with effusion (OME) is very common in pediatric patients. Immune reactions in serum and middle ear system play roles in the etiology, pathogenesis and prevention of otitis media. Immunologically active antigens interact with immunocompetent cells in the lamina propria of the middle ear to produce a local immune response. In this investigation, 32 sera and 50 middle ear fluid samples from children (ranged 1 to 10 years) with secretory otits media were analyzed for IgA, IgM, IgG, C3 and C4 by single radial immunodiffusion (SRID) and IgE by enzyme linked immunosurbent assay (ELISA) techniques. Our results indicated a highly significant increase in IgA and a decrease in IgM, IgG, IgB, C3 and C4 in secretion as compared to serum concentrations. The ratio of IgAJIgG, a valuable index of local immune response, was higher in the middle ear than in serum. These data support the hypothesis that there is an independent mucosal immune response in the middle ear mucosa to different stimuli.