Incidence and growth pattern of simple cysts of the kidney in patients with asymptomatic microscopic hematuria

BACKGROUND: We examined the incidence and natural history of simple renal cysts found by ultrasonography (US) in patients referred for asymptomatic microscopic hematuria. METHODS: Among the 906 patients aged 18-78 years, 743 patients who had undergone US were included in the present study. The natural history of simple renal cysts was investigated in 55 patients who underwent periodical US examinations for more than 3 years. RESULTS: The incidence of simple renal cysts was 4.3% for ages 29 years or younger, 15.3% for ages 30-39, 21.8% for ages 40-49, 23.3% for ages 50-59 and 32.6% for ages 60 years or older; thus the incidence increased in older age groups (P = 0.0005 for men, P = 0.0020 for women). Men tended to have a higher incidence than women. The degree of hematuria did not influence the incidence of renal cysts (P = 0.9044). The annual growth rate of the mean maximum diameter was 4.2% during a 3-year follow-up period in 55 patients and 5.1% during a 6-year follow-up in 31 patients. CONCLUSION: Since the diameter of a renal cyst may increase by 5% annually, the diameter of the cyst may increase by 1.6 times in 10 years. The scheduling of follow-up examinations depends on the size at the time of disclosure, the effects on calyceal systems, or the suspicion of a concurrent malignant disease. However, the most simple renal cysts may be followed-up at an interval of more than 10 years, once a diagnosis has been established.     

Pharmacokinetic and Pharmacodynamic Properties of FK070 (KDI-792), A Novel Thromboxane Receptor Antagonist/Thromboxane Synthetase Inhibitor,After Single and Multiple Oral Administrations to Healthy Volunteers

FK070, a thromboxane A₂ (TXA₂) receptor antagonist/TXA₂ synthetase inhibitor, was given orally to healthy male volunteers in a single-and multiple-dose study. In the single-dose study (200, 300, 400 mg), the area under the plasma concentration—time curve (AUC) and the maximum plasma concentration (C_max) increased non-linearly with dose, while the mean elimination half-life (t¹_β) was essentially unchanged (3.9-7.3 h). Recovery of the unchanged drug in the urine was 12–25%. C_max and AUC as determined with 200 mg of drug after a meal decreased by about 60 and 30%, respectively. Ex-vivo platelet aggregation in the plasma by a TXA₂ analogue, U46619, was almost completely inhibited within 1 h, after all doses of drug, with a significant dose-dependent inhibition maintained for 8 h or more, which was much longer than was expected from drug plasma concentration. The aggregation by adenosine diphosphate (ADP) was inhibited to a lesser extent. FK070 also inhibited TXA₂ synthetase as evidenced by decreased production of TXB₂ and reciprocally increased production of 6-keto-prostaglandin F_1α in the serum during ex-vivo whole blood coagulation. These effects peaked 1 h after drug and lasted until 4 h with the higher doses. In the multiple-dose study (300 mg, twice a day, after meals for 6.5 days), drug concentrations in the plasma were well fitted to a three-compartment open model with first-order absorption. FK070 afforded extensive inhibition of platelet aggregation by U46619 throughout the administration period, with a significant inhibition lasting as long as 48 h after conclusion of administration. No clearly drug-related changes were found in routine laboratory tests, subjective and objective findings, or vital signs. FK070 was concluded to be well tolerated and to provide long-lasting blockade of TXA₂ receptors, and plasma concentration-dependent inhibition of TXA₂ synthetase in the platelets.     

Simultaneous comparison of multiple molecules using tissue array analysis in the thyroid neoplasm

Aim: Differential diagnosis, including the respective distinctions between benign and malignant tumors, follicular and papillary neoplasms, and follicular adenoma and follicular carcinoma, are always required in clinical practice, because therapeutic strategy largely depends on the diagnosis made. Methods: The present study describes a novel approach to obtaining clinically useful markers by means of the simultaneous comparison of multiple molecules using tissue array analysis. The markers examined in this study include galectin‐3, CD44v6, p53, HBME‐1, maspin and S100A4, which were reportedly useful for making these distinctions in association with metastasis and invasion. A total of 45 cases of thyroid tumors (seven adenomatous goiters, 16 follicular adenomas, 12 follicular carcinomas and 10 papillary carcinomas) were analyzed. Results: The results demonstrated the following suggestive phenotypes: galectin‐3^‐, HBME‐1^‐ and maspin⁺ as benign lesions, galection‐3^‐, HBME‐1⁺ and maspin^‐ as follicular carcinoma, and galectin‐3⁺, HBME‐1⁺ and maspin⁺ as papillary carcinoma. Conclusions: The expression of the molecules was assessed in each case and the expression profiles were compared. Useful multiple molecules were selected for each distinction and were correlated with each other. To understand the complex relationship, a logistic regression model was constructed. These results suggested that combined analysis of multiple molecules enhanced the differential diagnostic accuracy.     

Bile acids influence hepatic chemiluminescence in normal and oxidative-stressed rats†

The aim of the present study was to clarify whether bile acids influence chemiluminescence (CL) in the liver in vivo. Hepatic CL was determined on the surface of the liver of anaesthetized rats by using a photon counter. In normal rats, hepatic CL was significantly decreased 30 min after enteral administration of chenodeoxycholic acid (CDCA) or deoxycholic acid (DCA), but returned to its initial level 3 h later, after part of the CDCA administered was metabolized. Ursodeoxycholic acid (UDCA) and cholic acid had no effect on CL. In contrast, hepatic CL was markedly increased 30 min after CDCA or DCA administration in rats given either buthionine sulphoximine (BSO), an inhibitor of γ-glutamylcysteine synthetase, or diethyldithiocarbamate (DDC), an inhibitor of both superoxide dismutase and glutathione peroxidase. Chenodeoxycholic acid further increased the CL of BSO- or DDC-treated rats during inhalation of oxygen via a tracheal cannula. Coadministration of UDCA eliminated the effects of CDCA on the hepatic CL of normal and BSO- or DDC-treated rats with or without oxygen inhalation. We conclude that cytotoxic bile acids, such as CDCA, increase CL in the antioxidants-depleted or oxidative-stressed liver in vivc, but that UDCA prevents CDCA from developing CL.     

Continuing Medical Education Program in Journal of Cardiovascular Electrophysiology

Article Title:  The Work-Up and Management of Patients with Apparent or Subclinical Cardiac Sarcoidosis: With Emphasis on the Associated Heart Rhythm Abnormalities.     

Early sigmoid colon carcinoma developed from a pedunculated polyp

A 60‐year‐old man underwent routine colonoscopy, and was noted to have a pedunculated polyp in the sigmoid colon. The pathologic diagnosis was adenoma, and due to patient’s personal circumstances, the lesion was left untreated. The colonoscopic examination was repeated 4 years and 11 months later, to find that the polyp had transformed into an elevated lesion with irregularly depressed surface. The patient was diagnosed as having early sigmoid cancer, and underwent sigmoidectomy. The histologic examination of the excised specimen revealed well‐differentiated adenocarcinoma with invasion into the submucosal layer. Through studying the natural course of colon cancer, it has become known that the advanced cancers commonly develop from polyps with short pedicles (sessile polyps). This case represents an early sigmoid cancer developed from a pedunculated polyp, which differs from the current mainstream concept of ‘polyp‐cancer sequence of colon cancer.’     

Acute myocardial infarction due to thrombus formation in congenital coronary artery fistula

A young female patient developed acute myocardial infarctionduring physical exercise. Coronary arteriography in the acutephase demonstrated a coronary fistula originating from the leftcoronary main trunk and communicating with the right atrium.Several branches of the left coronary artery were obstructedby thrombotic material originating from the fistula, causingan acute myocardial infarction.     

Evaluation of a computerized test system to screen for mild cognitive impairment

Background: Mild cognitive impairment (MCI) refers to the clinical condition between normal aging and Alzheimer's disease (AD) and has a high probability of developing into AD. Early detection of MCI is important because early detection and appropriate follow‐up treatment can prevent the disease from progressing. Therefore, MCI is an important candidate for screening and possible intervention. Methods: We have developed a computerized screening test system to identify cognitive decline. This system consists of six tests (age and year‐of‐birth validity test, three‐word memory test, time orientation test, first modified delayed‐recall test, visual working memory test and second modified delayed‐recall test). The scores obtained from three groups (MCI patients, AD patients and healthy control subjects) were analyzed to evaluate the sensitivity and specificity required for the screening of MCI. Results: The system was well accepted by the patients. All of the test procedures were completed within 5 min. Significant group differences in all test results were found. The system has sensitivity and specificity values of 82% and 87%, respectively, when used as a screen for MCI. Conclusion: The system is useful for the screening of cognitive disorders.