Comparison of Injection Materials for the Elevation of Gastric Mucosa Prior to Endoscopic Mucosal Resection

Endoscopic mucosal resection (EMR), namely strip biopsy, to eradicate gastric mucosal lesions requires certain special techniques, including submucosal injection of appropriate agents. This experimental study using dogs was conducted to compare, with regard to the degree of duration of mucosal elevation and subsequent histologic changes of the gastric wall, three injection materials; physiological saline, hypertonic saline with epinephrine (HSE) and 10% soybean oil. The duration of mucosal elevation which should be sufficient for the EMR procedure did not differ between the three agents. The post-injection histologic changes included vessel dilatation in the peri-muscularis mucosae, dilatation of the lymphatic channels and vessel congestion. These changes appeared in all injection material groups, and the vessel congestion was found to be more conspicuous in the HSE group. All EMRs in this series were performed by single snare cutting, which was also evaluated. The margin of the stripped material was well limited to the submucosal layer in all cases, but the depth of the ulcers formed varied. The healing process of the ulcer for the first 4 weeks was delayed in the soybean oil group. Although there were few cases of perforation in this experiment and some subjects had adhesion between the gastric serosa and adjacent organs, the single snare method could be applicable for clinical use by skilled hands.     

Epidemiological survey of foot diseases in Japan: Results of 30 000 foot checks by dermatologists

There has been no epidemiological survey of foot diseases in Japan. In this study we determined the prevalence of foot diseases, especially tinea pedis (TP) and tinea unguium (TU) in Japan. We conducted a randomized survey of outpatients who visited a dermatologist during the third week of May in 1999, 2000 and 2006. The most frequently reported condition was “fungal infection” in 8737 (40.0%) of 21 820 patients in 1999/2000, and 3848 (49.4%) of 7783 patients in 2006. The patients who visited a dermatologist for reasons other than superficial fungal infection but were diagnosed with TP or TU comprised 18.6% of the study population in 2000 and 24.1% in 2006. Of the patients with TP or TU, 63.2% used topical medication only. This survey showed that often patients are not aware of fungal infections and that their treatment is sometimes insufficient. Dermatologists should actively examine and treat patients with TP and TU.     

An Attempt to Assess the Replacement Dose of Human Growth Hormone in the Treatment of Growth Hormone Deficient Children

Hibi, I., Tanaka, T., Yano, H., Umezawa, S., Kagawa, J., Tanae, A. and Ishikawa, E. (National Children's Medical Research Center, Tokyo, the National Children's Hospital, Tokyo and the Department of Biochemistry, Miyazaki Medical College, Miyazaki, Japan). Acta Paediatr Scand [Suppl] 337:87, 1987.
In 25 patients with hGH deficiency, who had been treated long-term with hGH, the mode of hGH administration was switched from the conventional method (0.3–0.5 IU/kg/week, in two or three divided doses, intramuscularly) to daily subcutaneous injection at 1900–2100 hours with a dose of 0.46 ± 0.07 IU/kg/week (equivalent to 14.7 ± 2.0 IU/m²/week). After 1–3 months of this new mode of hGH administration, blood and urine were sampled at 0900 hours after overnight fasting. Blood glucose, plasma insulin, plasma IGF-1 and plasma total IGF (after extraction) were analysed in blood samples. IGF-1 and hGH were measured in urine samples. These measurements indicated that the dose studied was close to a replacement one, but might be slightly higher than the exact replacement dose.     

Dual colour fluorescein analysis of peripheral blood T cells in auto-immune chronic active hepatitis

Both CD4 and CD8 T cells are subdivided into two phenotypically distinct sublineages via another two T cell markers, Leu-8 and CD11b antigens. The proportions of these four T cell subsets, CD4+Leu8+, CD4+Leu8-, CD8+11b+ and CD8+11b-, were studied in patients with auto-immune chronic active hepatitis (CAH) and compared with disease controls (hepatitis B surface antigen positive chronic active hepatitis) and healthy controls. We found that the proportion of CD4+Leu8+ cells was significantly reduced compared with controls (P less than 0.01), whereas those of the other cells were almost identical in all 3 groups. The absolute number of these CD4+Leu8+ cells was also lower than that of controls (P less than 0.01). Thus, the present study suggests that a reduced number of CD4+Leu8+ cells is associated with the aberrant immune response in auto-immune CAH.     

3-Dimethylphosphinothioyl-2(3H)-oxazolone (MPTO), a promising new reagent for racemization-free couplings

3-Dimethylphosphinothioyl-2(3H)-oxazolone (MPTO) was synthesized, and its ability to effect racemization-free couplings and cyclization of a peptide and its C-terminal epimer was examined. MPTO showed good reactivity in aprotic polar solvents such as N,N-dimethylformamide (DMF) and N-methylpyrrolidone. In reactivity MPTO resembles DPPA and dimethylphosphinothioyl azide (MPTA) previously developed by us, but it is much better than these reagents because the side reactions specific to the azide method could be avoided. In coupling of Z-Gly-Val-OH with H-Val-OMe in DMF at 0°C, no racemization was observed without use of racemization-suppressing additives. Slight racemization observed at room temperature could be completely suppressed by addition of HOBt but not by HOSu. The utility of MPTO was demonstrated by the synthesis of cyclo-(d -Trp-d -Glu(OBzl)-Ala-D-Val-Leu), an intermediate for an endothelin-binding inhibitor BE 18257A. In a comparative study using DPPA, MPTA and MPTO, no racemization was observed for MPTA or MPTO, while DPPA caused considerable racemization. When MPTO was used in the presence of HOBt rapid cyclization (3 h at RT) occurred to give the optically pure cyclic product.     

Multiple Early Gastric Carcinoma in Cases Treated Endoscopically

Multiple gastric carcinoma was endoscopically diagnosed in 14 patients (13.6%) with 33 lesions (27.3%), out of 103 cases of early gastric carcinoma treated by endoscopic surgery. The sex ratio of these patients was 11 males to 3 females, and their mean age was 61.7 years old. In 79% of the patients the macroscopic type of the lesions was the same. Twelve of 33 lesions were metachronous lesions diagnosed by endoscopy using the dye contrast method. All of the metachronous lesions were evaluated as invading only as far as the mucosa. Almost all of the metachronous lesions were located at a height similar to that of the initial lesion or in a more oral direction. Eleven of 12 metachronous lesions were less than 2 cm in diameter, including 5 minute cancer lesions which were less than 5 mm in size. All these lesions were treated again endoscopically without gastrectomy. These results suggest that an annual endoscopy using the dye contrast method permits early detection of gastric carcinoma at a stage at which it can be treated endoscopically.