LAPAROSCOPY-GUIDED PERCUTANEOUS CHOLECYSTOLITHOTOMY: AN EVOLVING TECHNIQUE

Gall-bladder conservation therapy has been evolving during the past decade. Popular techniques of conservative therapy are extracorporeal shock wave lithotripsy (ESWL) and medical dissolution therapy. The limitations of these procedures have prompted a search for alternative techniques, particularly in relation to percutaneous stone extraction. The cases of four patients with symptomatic gallstones who underwent percutaneous cholecystolithotomy under laparoscopic guidance are reported. The gall-bladder was punctured with a long needle and the tract dilated so that a nephroscope could be introduced. Three cases required stone fragmentation by an ultrasonic lithotripter before removal. Postoperative recovery was uneventful in all cases.     

Illiteracy, Ignorance, and Willingness to Quit Smoking among Villagers in India

During the field work to control oral cancer, difficulty in communication was encountered with illiterates. A study to define the role of illiteracy, ignorance and willingness to quit smoking among the villagers was undertaken in a rural area surrounding Doddipatla Village, A.P., India. Out of a total population of 3,550, 272 (7.7%) persons, mostly in the age range of 21–50 years, attended a cancer detection camp. There were 173 (63.6%) females and 99 (36.4%) males, among whom 66 (M53 + F13) were smokers; 36.4% of males and 63% of females were illiterate. Among the illiterates, it was observed that smoking rate was high (56%) and 47.7% were ignorant of health effects of smoking. The attitude of illiterate smokers was encouraging, as 83.6% were willing to quit smoking. Further research is necessary to design health education material for 413.5 million illiterates living in India (1991 Indian Census). A community health worker, trained in the use of mass media coupled with a person-to-person approach, may help the smoker to quit smoking.     

Negative and depressive symptoms in suicidal schizophrenics

The aim of this study was to determine the value of positive, negative and depressive symptoms, and of the dexamethasone suppression test (DST), in differentiating schizophrenics with and without a history of suicide. Fifty-seven hospitalized patients with schizophrenia were assessed at the end of a neuroleptic free interval with the Brief Psychiatric Rating Scale (BPRS), the Hamilton Rating Scale for Depression (HRSD), and with a dexamethasone challenge. Suicide attempters were significantly more likely to meet criteria for major depression than nonattempters. Scores on the HRSD differentiated the two groups whereas the sums of positive and negative symptom items from the BPRS did not. DST a.m. and p.m. cortisol values differentiated suicide attempters from nonattempters and HRSD scores correlated significantly with cortisol levels. This study confirms the importance of depressive symptoms in schizophrenic patients with a history of suicide. Assessment of the hypothalamic-pituitary-adrenal axis in schizophrenia may also provide useful information.     

The reliability and validity of the Chinese Polarity Inventory

For the simultaneous measurement of manic and depressive symptoms, the Chinese Polarity Inventory (CPI), a 20-item self-report scale, was developed. A total of 329 depressive and 356 manic/hypomanic patients were recruited in this scale developmental study in China. All patients completed the CPI and either the Chinese version of the Hamilton Depression Rating Scale (for depressed subjects) or the Chinese version of the Bech-Rafaelsen Mania Scale (for manic subjects). The CPI was found to have excellent reliability and satisfactory concurrent validity. Construct validity analysis was performed using principal component analysis, which yielded 4 clinically meaningful factors: activity, pleasurability, capability and irritability. The CPI was sensitive in differentiating different severities of depression and mania. However, its ability to differentiate mixed phase from other mood states and its sensitivity to changes during the treatment still need to be studied further.     

Risk factors of aseptic intracranial venous occlusive disease

Introduction – Risk factors for aseptic intracranial venous occlusive disease are varied but only few epidemiologic studies were performed to verify the relative importance of particular factors. Patients and methods – A 2-year hospital-based prospective study was conducted in two hospitals to identify the clinical characteristics and risk factors of patients with confirmed aseptic intracranial venous occlusive disease. Results – 21 patients were identified, representing 0.9% of the total neurological admissions. Men were more commonly affected than women; 81% of the patients presented in a clinical picture indistinguishable from idiopathic intracranial hypertension. Risk factors included Behçet's disease in 4, the puerperium in 3, thrombophelia in 3, familial Mediterranean fever in 2, malignancies in 1, lupus anticoagulant in 1, and the contraceptive pill in 1. Conclusion – Aseptic intracranial venous occlusive disease proved to be not rare in Arabs. It should be considered seriously in the differential diagnosis of idiopathic intracranial hypertension, particularly in males. Several risk factors were incriminated.     

Natural evolution of snoring: a 5-year follow-up study

Introduction – The natural evolution of snoring was studied in a middle-aged population in Finland. Material and methods – A questionnaire was mailed to a stratified random sample of 1600 people aged 36–50 years in 1985 with a response rate of 75.2%; 53% of them completed also the 5-year-follow-up questionnaire. Clinical examinations (N = 36) and whole-night polygraphic recordings (N = 22) were made to habitual (every or almost every night) snorers and daily sleepy persons. Results – A total of 626 persons completed the 5-year-follow-up questionnaire. The prevalence of habitual snoring among men was 28.3–43.8% and among women 6.3–18.8%, increasing with age. Sleepiness was common: doze-off at the wheel was reported by 23% of snorers and traffic accidents because of sleepiness by 4.5%. Hypertension was clearly more common (p = 0.002) among habitual snorers, but the self-reported rates of strokes and coronary heart disease were not increased in this study. None of the snorers had been investigated because of their snoring or sleepiness during the five years. In polygraphic recordings 11/22 showed an oxygen desaturation index (ODI4) more than 5/h; active treatment was started for 8 of them. The observed prevalence of sleep apnea syndrome with ODI4> 10 was 1.1% in this study. Conclusions – Snorers, even with clear sleepiness, are passive in seeking help for their symptoms. Physicians should actively diagnose this treatable condition impairing the quality of life and increasing the risk of traffic accidents and vascular diseases.     

High Human IgG Levels in Severe Combined Immunodeficient Mouse Reconstituted with Human Splenic Tissues from Patients with Gastric Cancer

We implanted normal peripheral blood lymphocytes (PBL) from healthy donors and splenic tissues from patients with gastric cancers into the severe combined immunodeficient (SCID) mouse, demonstrating that SCID mouse with splenic tissue can produce a high level of human immuno-globulin G (IgG). The normal PBLs at 10⁷ and 10⁸/mouse were implanted intraperitoneally, and three splenic tissues with a size of 3×3×3 mm from gastric cancer patients were inoculated subcutaneously into the bilateral backs of the mice. At 2, 4, 6 and 8 weeks after inoculation, mice were killed, and the human IgG was assessed by an ELISA method. SCID mice with splenic tissue revealed high human IgG levels from 2 weeks after inoculation and approximately 2 mg of IgG per ml was observed at 8 weeks post-implantation, while the IgG levels in mice treated with PBLs were limited. Since the half life of the extrinsic human IgG was 10.2 days, the high level of human IgG in the SCID mice was supposed to be produced by human plasma cells in the splenic tissue from gastric cancer patients. This model was thought to be adequate for evaluating human immunological functions in vivo.     

Metabolism of Tegafur in Rat Liver Observed by in vivo 19F Magnetic Resonance Spectroscopy and Chromatography

Metabolism of tegafur in the rat liver was observed by in-vivo ¹⁹F magnetic resonance spectroscopy (MRS). After MRS observation, tegafur and q-fluorouracil (S-FU) in the liver were determined by a shromatographic method for comparison with the results of ¹⁹F-MRS. Rats were divided into 3 groups: 1) CCl4-induced liver injury group, 2) uracil combined group, 3) control group. Catabolism to fluoro-β-alanine was suppressed in both the liver injury group and the uracil combined group. Low peaks of 5-FU and fluoronucleotides could be found only in the uracil combined group. The result of ¹⁹F MRS observation of each group was in agreement with the result of determination of tegafur and 5-FU by chromatography. This showed that substances which could be observed by ¹⁹F-MRS were in proportion to all intracelluar fluoro-containing substances. ¹⁹F-MRS can provide direct information on the metabolism of fluoropyimidines non-invasivey and it might be a useful aid in choosing suitable shemotherapy for patients.     

Mouse-Human Chimeric Antibody MH171 against the Multidrug Transporter P-Glycoprotein

We have developed a mouse-human chimeric antibody MH171, in which the antigen-recognizing variable regions of the mouse monoclonal antibody MRK17 are joined with the constant regions of human IgG1 antibodies. The MRK17 recognizes specifically the multidrug transporter P-glycoprotein and inhibits the growth of human multidrug resistant (MDR) tumor cells in vitro and in the xenograft nude mouse model system. The established chimeric MH171 antibody forms an apparently intact IgG composed of heavy and light chains covalently assembled via disulfide bonds in sodium dodecyl sulfate polyacrylamide gel electrophoresis analysis and is specific to MDR cell lines with a similar affinity to the original mouse MRK17. MH171 also displays strong antibody-dependent cell-mediated cytotoxicity to the target cells in vitro , when human mononuclear cells are used as effector cells. The chimeric antibody against P-glycoprotein, MH171, should be a useful agent in the treatment of human drug-resistant tumors.     

Modifying Effects of Various Chemicals on Tumor Development in a Rat Wide-spectrum Organ Carcinogenesis Model

The efficacy of a wide-spectrum organ carcinogenesis model for detection of modification potential of exogenous agents was investigated in F344 male rats. Groups of animals were sequentially injected with N-bis(2-hydroxypropyl)nitrosamine (1000 mg/kg body weight, i.p., in saline, twice in week 1), N-ethyl-N-hydroxyethylnitrosamine (1500 mg/kg body weight, i.g., in distilled water, twice in week 2) and 3,2'-dimethyl-4-aminobiphenyl (75 mg/kg body weight, s.c., in corn oil, twice in week 3) for wide-spectrum initiation of target organs and then given one of 10 test chemicals, comprising 6 hepatocarcinogens and 4 non-hepatocarcinogens, for 12 weeks. All 10 chemicals exerted modifying effects in their respective target organs. Enhancing influence could be detected in the liver and urinary bladder with 2-acetylaminofluorene, ethionine, and 3'-methyl-4-dimethylaminoazobenzene; in the liver and thyroid with 4,4'-diaminodiphenylmethane and phenobarbital; in the esophagus and urinary bladder with N-butyl-N-(4-hydroxybutyl)nitrosamine; in the forestomach and urinary bladder with butylated hydroxyanisole; in the liver with 7,12-dimethylbenz[a]anthracene and in the liver and lung with 3-methylcholanthrene. Inhibitory effects on development of glutathione S-transferase placental form-positive liver cell foci were observed with clofibrate. The results indicate that the present model can be reliably utilized as a whole body medium-term bioassay system for assessment of environmental cancer modifiers.