Retrospective study on stage B prostate cancer in the Hokuriku District, Japan

BACKGROUND: The present study was conducted to investigate how patients with clinically localized prostate cancer were treated in the Hokuriku District, Japan. METHODS: Medical records of 536 patients with stage B prostate cancer were retrospectively reviewed. The patients were diagnosed and treated at four university hospitals and 32 collaborating hospitals in the Hokuriku District. RESULTS: Because their medical records were incomplete and/or they not available for follow up, 79 cases were excluded from this study. Conservative treatment with hormone therapy was used for 248 cases. Radical prostatectomy was performed in 199 cases, only 27 of whom underwent surgical monotherapy. There was no significant difference in disease-specific survival rates between the hormone (69.0%) and surgery group (83.2%) after 110 months. Results of the analysis of disease-specific survival rates according to histologic grade showed that patients with poorly differentiated cancers treated with hormone therapy were the only subset with significant differences when compared against the other patients. CONCLUSION: The value of prostatectomy alone or added was marginal in terms of survival. Only patients with poorly differentiated cancer might benefit from prostatectomy.     

BONE RESORPTION BY TARTRATE-RESISTANT ACID PHOSPHATASE-POSITIVE MULTINUCLEAR CELLS ISOLATED FROM RHEUMATOID SYNOVIUM

Inflammatory reactions in rheumatoid arthritis (RA) often causesevere joint destruction. However, the mechanism of bone destructionis still a matter of controversy. To determine whether multinuclearcells found in the rheumatoid synovium can resorb bone, isolatedsynovial cells were assessed for tartrate-resistant acid phosphatase(TRAP) staining and the ability to resorb bone in a dentineresorption assay. TRAP-positive multinuclear cells were foundin six out of 10 samples. These six samples showed resorptionpit formation on dentine slices. The other four samples didnot form resorption pits. The results of this study demonstratethat TRAP-positive multinuclear cells isolated from the rheumatoidsynovium form resorption pits on dentine slices. Our resultssuggest that inflamed synovial cells in rheumatoid joints mightparticipate in bone destruction. KEY WORDS: Bone resorption, Rheumatoid arthritis, Pit formation, Synovial cells, Osteoclast-like cells, Tartrate-resistant acid phosphatase     

FLUMAZENIL DOES NOT ANTAGONIZE HALOTHANE, THIAMYLAL OR PROPOFOL ANAESTHESIA IN RATS{dagger}

We have studied the effects of flumazenil on sleep time andEEG in rats anaesthetized with 1.5% halothane, propofoi 20 mgkg^–1, thiamylal 30 mg kg^–1, or combinations of diazepam5 mg kg^–1 and anaesthetic agents. We also studied theeffects of flumazenil 0.3, 3 and 30 mg kg^–1 on behaviourand EEG. Flumazenil 0.3 and 3 mg kg^–1 alone had no effecton behaviour or EEG, but flumazenil 30 mg kg^–1 had depressiveeffects similar to those of diazepam on behaviour and EEG. Flumazenil0.3, 3 and 30 mg kg^–1 i.v., antagonized the effects ofdiazepam 10 mg kg^–1 i.v. on behaviour and EEG. Flumazenilhad no antagonistic effect on sleep time induced by anaestheticagents, but flumazenil 30 mg kg^–1 potentiated propofol-inducedanaesthesia. Flumazenil did not affect anaesthesia-induced EEGchanges. Diazepam 5 mg kg^–1 potentiated anaesthesia. Flumazenilantagonism of diazepam potentiation varied with anaestheticagent: flumazenil 0.3 mg kg^–1 antagonized diazepam actionin halothane anaesthesia, but 30 mg kg^–1 was requiredin propofoi anaesthesia; this large dose was insufficient inthiamylal anaesthesia. ^*Present address: Department of Anesthesia, Omiya Medical Center,Omiya 330, Japan.      

Discrimination between His-bundle and the Right Bundle Branch during Electrophysiologic Studies

Background: The purpose of this study was to identify the His-bundle (HB) versus right bundle branch (RBB) during electrophysiologic studies, using the V3 phenomenon, and to compare the timing of HB versus RBB potentials of sinus cycles (His-ventricular [H-V] interval).
Methods: The study enrolled 16 patients without structural heart disease, who underwent electrophysiologic studies during which the H-V interval was within normal limits and the V3 phenomenon was induced during recordings of the HB and the RBB potentials by a multi-electrode catheter. The recording site of the earliest HB potential just before the V3 phenomenon was defined as the branching portion of His bundle (HBBP), the site immediately proximal to the HBBP as the HB, and the site immediately distal to the HBBP as the RBB.
Results: The HBBP was identified in all patients. In all cases but one patient, the H-V interval measured at the HB adjacent to the HBBP was ≥35 ms. However, in 12 patients, the H-V interval measured at the RBB adjacent to the HBBP was also ≥35 ms.
Conclusions: The electrophysiologic identification of HB versus RBB by simultaneous recordings of HB and RBB potentials during induction of the V3 phenomenon was feasible. When the discrimination between HB and RBB was based on the measurement of the H-V interval, the proximal portion of the RBB was frequently misidentified as the HB.     

Early detection of cutaneous microcirculatory change during hemorrhage using a laser Doppler flowmetry

The purpose of the present study was to evaluate the usefulness of cutaneous microcirculatory monitoring during hemorrhage. We observed changes in cutaneous blood volume, velocity and flow of five adult rabbits during hemorrhage by using a laser Doppler flowmetry. Mean arterial blood pressure, heart rate and blood gas values were measured. Cutaneous blood volume, velocity and flow decreased significantly after drawing 10 mL/kg of blood, while heart rate, mean arterial blood pressure and blood gas did not change. The decrease of cutaneous blood velocity preceded that of blood volume and was associated more deeply with the reduction of blood flow. In conclusion, cutaneous microcirculatory monitoring using laser Doppler flowmetry is a sensitive technique for detecting early changes of circulatory failure caused by hemorrhage.     

Plasma Proteins Case Report: Massive Bone Marrow Necrosis with Polyclonal Hypergammaglobulinemia and Blue Toe Syndrome

Massive bone marrow necrosis was rare, and most of these cases were accompanied with malignant disease. We report a case that was thought to be idiopathic massive bone marrow necrosis. It was a 58 y.o. male who was admitted because of blue toe syndrome and hypergammaglobulinemia. We tried to detect malignant diseases with computed tomography and gallium scintigraphy, and infectious diseases with bacterial culture and viral antibodies, but all of them were negative. Pancytopenia and bone marrow necrosis was not improved, and he had died after 5-month hospitalization. Autopsy revealed massive bone marrow necrosis and bone marrow fibrosis after necrosis, but malignant or infectious diseases were not detected. It may be diagnosed as idiopathic massive bone marrow necrosis.     

Pathological effects of neoadjuvant hormonal therapy help predict progression of prostate cancer after radical prostatectomy

BACKGROUND: It is not clear whether pathological changes following neoadjuvant hormonal therapy (NHT) prior to radical prostatectomy have any value as predictors of progression in prostate cancer. METHODS: We conducted a study of 100 patients with prostate cancer who underwent radical prostatectomy following NHT. We used the Japanese general rule as the criterion to assess the biochemical recurrence rate and pathological changes after NHT. RESULTS: In terms of preoperative risk factors, the probability of recurrence was significantly higher for patients with more than 20 ng/mL of pretreatment serum prostate-specific antigen (PSA) and/or a Gleason score of 7 or higher for biopsy specimens. We defined these pretreatment findings as high-risk factors. Among 65 patients with high-risk factors, patients with a post-NHT pathological effect of grade 3 according to the Japanese general rule showed no recurrence, whereas patients with a grade 0 had a poor prognosis. Patients with a PSA nadir 0.5 ng/mL or less tended to have a better prognosis. CONCLUSION: Despite preoperative high-risk factors, patients showing good pathological effects after NHT tend to have a favorable prognosis after radical prostatectomy. Therefore; assessment of the pathological effects of NHT using the Japanese general rule as the criterion proved to be useful for the prediction of biochemical recurrence.     

E.E.G. ACTIVITY DURING HALOTHANE ANAESTHESIA IN MAN

The effects of i.v. administration of suxamethonium and noxiousstimulation induced by skin incision on the e.e.g. were studiedduring halothane anaesthesia in man. These stimuli induced activationof the e.e.g. which was represented by either low-voltage fastwaves or high-voltage slow waves. The low-voltage fast waveresponse was observed in adult patients while the high-voltageslow wave response was the predominant response in infants andchildren aged less than 8 yr. Suxamethonium induced the high-voltageslow wave response in 77% of cases; skin incision in 88%. Thee.e.g. of four infants aged less than 60 days did not show activationwith either stimulus. Both types of e.e.g. activation were associatedwith an increase in heart rate, increase in arterial pressureand pupillary dilatation. The possible mechanisms involved inthe production of activation of e.e.g. by i.v. administrationof suxamethonium are discussed.