AP-811, a novel ANP-C receptor selective agonist

AP-811 is a derivative of the Phe8-Ile15 region of atrial natriuretic peptide (ANP) and is one of the smallest linear ligands for ANP receptors. The binding and agonist activities of AP-811 have been compared with those of other ANP analogs for the ANP-A and ANP-C receptors. AP–811 binds with a high binding affinity to and is a strong agonist for the ANP-C receptor, indicating that the binding and agonist sites for this receptor are the same or near each other in the ANP sequence. In contrast, AP-811 showed no agonistic effect for the ANP-A receptor, although it could bind to this receptor. Comparing the biological activities of AP-811 with those of other ANP analogs, we propose that the binding and agonist sites for the ANP-A receptor may consist of separate regions of ANP. In conclusion, AP-811 is the smallest C-receptor-selective agonist.     

Peritoneoscopic cholecystectomy has opened the door to minimally invasive surgery

In 1989 a new trend occurred in the surgical treatment of a diseased gall-bladder, laparoscopic cholecystectomy (LC). Laparoscopic surgery is now accepted world-wide as the choice of treatment with the advantages of less pain, good cosmesis, short hospital stay and early recovery. It is also a curative procedure for cholelithiasis as well as a cholecystectomy. The rate of conversion to open surgery is about 5% and the rates of bile duct injury are 0.1–0.6%. This new approach revives controversies concerning cholecystectomy; namely indication, use of intra-operative cholangiography, ductal calculi and pregnancy. There are new issues to consider, including use of a Veress needle for pneumoperitoneum, type of trocars, cardiovascular responses to pneumoperitoneum using carbon dioxide and so on. With increasing use, these difficulties will be overcome. Advances in technology are expected to make even more new types of surgery possible, even perhaps extending into robotic surgery.     

Colonic Angiomyolipoma

Abstract: Angiomyolipoma is a rare benign tumor which usually occurs in the kidney with tuberous sclerosis. We encountered a case of angiomyolipoma of the cecum not associated with tuberous sclerosis. To our knowledge, this is only the third case reported in the international literature.     

Primary gastric lymphoma with arterial bleeding

We experienced a case of primary gastric lymphoma with arterial bleeding. The case was an 88‐year‐old‐man who was admitted to our hospital with hematemesis. Gastroduodenal endoscopy revealed a gastric ulcerating tumor with arterial bleeding in the posterior wall of the angular gastric region, and a distal subtotal gastrectomy with lymph node dissection was performed. The resected tumor measured 7.0 × 3.0 cm in size with a blood vessel visible in the bottom of the ulcer. Pathologic examination confirmed a diagnosis of B‐cell malignant lymphoma of the diffuse large cell type. Metastasis was detected in nos 3 and 5 lymph nodes. According to the Ann Arbor and Naquvi classifications, the lymphoma was stage IIE and II, respectively. One year and 10 months after the operation, a computed tomography scan revealed a few swollen lymph nodes around the abdominal aorta. Recurrence of lymphoma was confirmed and chemotherapy comprising cyclophosphamide, doxorubin, vincristine and predonisolone was given at half the ordinary adult dose.     

Proliferative activity in intrahepatic metastasis of hepatocellular carcinoma

To assess the characteristics of intrahepatic metastatic lesions (IML) in hepatocellular carcinoma (HCC), we analysed both the histological features and proliferative activities of 15 resected cases of HCC accompanied by IML. The histological features of the IML were essentially the same as those observed in the main nodules in 12 (80%) of 15 cases. In 13 (87%) of 15 cases, the labelling index of proliferating cell nuclear antigen (PCNA) in the IML was either higher than or the same as in the main nodules. In 10 (77%) of 13 cases, the MIB-1 labelling index in the IML was either higher than or the same as in the main nodules. The results indicate that the histological features of the IML are essentially the same as those of the main nodules, while the proliferative activities in the IML were generally higher than those in the main nodules. Such characteristics may thus provide a clue to help distinguish intrahepatic metastasis from the multicentric occurrence of HCC.     

A long-term survivor of ruptured hepatocellular carcinoma after hepatic resection

Abstract We treated a patient who had previously undergone a hepatic resection for ruptured hepatocellular carcinoma (HCC) but developed a solitary peritoneal recurrence at the site of the incision 8 years and 9 months later. Since no other recurrence was evident, we resected the tumour. The primary tumour was 2.5 cm in size and histological examination revealed HCC without any histological risk factors for intrahepatic recurrence. The peritoneal tumour consisted of less differentiated cancer cells than those found in the primary tumour. The positive rates of Ki-67 were 10% in the primary tumour and 23.3% in the peritoneal recurrence. The DNA indexes in both tumours were considered to be identical.
The comparison between the primary and peritoneal tumours suggested that the histological differentiation and proliferation activity can change after recurrence, in spite of consistent DNA ploidy contents. Clinically, a patient who undergoes a hepatic resection for ruptured HCC can survive for a long time, such as 10 years, if they have good liver function and small HCC without any histological risk factors for intrahepatic recurrence. However, since late recurrence is possible, a follow up for as long as 10 years is recommended.     

INCREASED SERUM OESTRONE AND OESTRADIOL FOLLOWING SPIRONOLACTONE ADMINISTRATION IN HYPERTENSIVE MEN

The present study was undertaken to evaluate long-term effects of spironolactone on basal serum oestrone, oestradiol, testosterone, LH and prolactin concentrations in hypertensive male patients. Serum prolactin response to TRH was also evaluated. Patients were divided into two groups: a conventional-dosage group, consisting of six males with essential hypertension who took 75 to 150 mg of spironolactone daily for 12 weeks, and a high-dosage group, consisting of two males with idiopathic hyperaldosteronism who took 300 mg of spironolactone daily for more than 40 weeks. In the conventional-dosage group, serum oestrone concentrations significantly increased (P > 0.01) at 12 weeks, serum oestradiol concentrations gradually increased throughout the study period, however, the increments were not statistically significant (P > 0.2). Basal serum testosterone, LH and prolactin concentrations were not significantly changed throughout the study period. Enhancement of serum prolactin response to TRH was not found in any of the patients in the conventional-dosage group. In the high-dosage group, serum oestrone maintained high levels from the beginning of this study, and serum oestradiol concentrations increased with the development of gynaecomastia. Serum testosterone, LH and prolactin concentrations did not show any definite change throughout the study period. Thus, long-term spironolactone treatment increased the serum levels of oestrone and oestradiol in hypertensive men followed by the development of gynaecomastia. The elevations in circulating oestrogens could well explain the oestrogenic side-effects of spironolactone treatment.     

Classification of gastric lesions associated with portal hypertension

Abstract There are two gastric mucosal lesions which commonly occur in patients with portal hypertension; one is portal hypertensive gastropathy and the other is gastric varices. These lesions occasionally cause fatal haemorrhage. Several classifications for these lesions have been proposed, but none of them have been evaluated prospectively. We consider it better to classify portal hypertensive gastropathy into three stages including non-specific redness, specific mosaic pattern and red spots. Gastric varices may be classified according to form, location and mucosal lesions. Prospective trials are needed to obtain more practical evidence for the accurate classification of these gastric lesions.     

Max protein expression is associated with survival of children with lymphoblastic lymphoma

Overexpression of c-Myc in murine B lineage cells is associated with a polyclonal pre-B cell expansion as well as development of pre-B or B lymphoblastic lymphoma (LL) accompanied by leukemia, which mirrors the clinical features of childhood LL. Of interest, Max overexpression attenuates aberrant growth of B cells triggered by c-Myc. However, the clinical significance of Max in human lymphoid tissue remains to be clarified. In the present studies, we studied the expression of the c-Myc and Max proteins in normal lymph nodes and in childhood LL. In normal lymph nodes, c-Myc protein was expressed by the majority of cells in germinal center and marginal zone, but Max protein was expressed only by some of them. In contrast, c-Myc and Max were absent in mantle zone. Cells positive for c-Myc and Max expression in LL were 70.6 +/- 19.8% and 47.3 +/- 32.4%, respectively, determined by immunohistochemical staining using paraffin blocks from 23 cases of childhood LL. The survival of children with LL showing higher Max expression (> or = 30%) was significantly greater than that of lower expression (< 30%; P = 0.0027 using the Mantel-Cox test). These results suggest that Max protein may affect prognosis of childhood LL.